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Is Comedy a Prerequisite to a Successful Medical Career?

— Milton Packer explores the innumerable reasons why laughter is essential to medicine

MedpageToday
A photo of Volodymyr Zelensky performing a a comedy show.
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    Milton Packer is distinguished scholar in cardiovascular science at Baylor University Medical Center at Dallas and visiting professor at Imperial College in London.

Like everyone else, I have been reading the distressing headlines about the Ukraine. The most important figure in the current conflict may be Vladimir Putin. But the most fascinating person is Volodymyr Zelenskyy (anglicized Zelensky).

A long-standing advocate of Ukrainian-Russia harmony, Zelenskyy was elected in a landslide as the President of the Ukraine in 2019. Although he initially underestimated the extent of Putin's ambitions, Zelenskyy has become the central symbol for the Ukrainian resistance. Most people expected Zelenskyy would abdicate, fleeing the country to save his own life and the lives of his immediate family. Instead, Zelenskyy has stated unequivocally (and bravely) that he is staying in the Ukraine to lead both his people and their military response. Zelenskyy's personal response has single-handedly inspired the severity of sanctions from the West and turned the tide of the war.

We do not expect such extraordinary courage from our leaders, who typically hide in fear of a bad opinion poll. But Zelenskyy has one unique qualification for this Spartacus moment: his first career choice was in comedy. Zelenskyy was a serious actor and comedian, winning comedy competitions and producing highly successful comedy films. In 2015, Zelenskyy was the star of the television series, "Servant of the People," where he played the role of the president of Ukraine. The series was so successful that the people of Ukraine made fiction into a reality.

As The Economist , the boundaries between politics and stand-up comedy have been blurred for a long time. Comedians are running for public office, and our political leaders are making a serious effort to be funny (sometimes).

If you think comedy has no role in a discipline devoted to serious affairs, think again. Take the healthcare field as yet another example: there has always been a special relationship between comedy and medicine.

I am not joking.

Comedy is not about making people laugh. The core value of comedy is the "comic frame," as described so well by Kenneth Burke. The "neither wholly euphemistic, nor wholly debunking -- hence it provides the charitable attitude towards people that is required for purposes of persuasion and cooperation." The purpose of the comic frame is to satirize a given circumstance so as to provoke thought and promote change. According to George Meredith, the flourishing of comedy is a critically important test of the health of a civilization.

Beyond the health of civilizations, comedy is critically important to the health of individuals. It is claimed that get less sick than those who do not.

In short, comedy is one of the highest forms of empathic communication and one of the most effective mechanisms of promoting healthy change.

Ever wonder what makes patients think their physician is special? Let us assume that you have 10 minutes to talk to a patient. How do you ensure the time you spend is memorable and effective? The physician must understand and empathize with the patient's plight. Connecting with someone based solely on the facts may or may not be effective. The patient who smiles (or even laughs) during a physician visit will remember what the physician said. Or as Victor Borge once said: "Laughter is the shortest distance between two people." Voltaire takes it one step further: "The art of medicine consists of amusing the patient while nature cures the disease."

The Pritzker School of Medicine at the University of Chicago as part of the medical educational experience. The principles of stand-up comedy have been used to promote of interpersonal biases in medicine. Second City, the famed comedy club in Chicago, has developed modules in healthcare. Watching comedy routines in patients undergoing surgical oncology procedures. Two randomized trials have reported that watching comedy is to improving .

Do you still have doubts? You have heard that laughter is the best medicine. Do you know where that aphorism comes from? It comes from the Bible (Proverbs 17:22): "A merry heart doeth good like a medicine: but a broken spirit dries up the bones."

Adoption of a comic framing is also essential to the success of those who provide healthcare. Physicians and nurses struggle constantly with the stresses of patient illnesses, the failure of treatments to work effectively, and the errors made in an effort to deliver quality care. Nurses with a sense of humor have , when compared to those who do not. Once, I was watching in the operating room when a surgical procedure suddenly went badly, requiring the entire team to work with exceptional rapidity to save the patient's life. The lead surgeon's sense of humor was a critical ingredient to getting the surgical team to set aside their panic and focus on their skills.

Some physicians are so good at comedy that they decided against a long-term commitment to medicine and elected a career in comedy. Ken Jeong is a very successful comedian who has appeared in many well-known movies. But did you know he graduated from the University of North Carolina School of Medicine, did his residency in internal medicine at Ochsner in New Orleans, and practiced medicine for several years before turning his effort full time to his entertainment career?

This story resonates with me. My first paying job was as a stand-up comedian in State College, Pennsylvania in the late 1960s. I did a 15-minute routine, once or twice a week, delivered to patrons of a local college hangout. Some nights went better than others, but admittedly, many nights were really awful. Most of the other comedians who performed in the club were far better than I.

I never considered comedy as a professional option. But I met several comedians who really wanted to make it big. Interestingly, for those with lofty goals, doing comedy was amazingly stressful. Every night they performed, they would put their own self-esteem on the line since their past performances never counted in their favor. On the nights you bombed, no one in the audience cared how funny you were the week before. And for some, comedy was a mechanism for dealing with their own internal demons. Perhaps, it is not surprising that career comedians (particularly successful ones) have .

I never abandoned my love of comedy. When I was at Mount Sinai in New York in the 1980s, my evening rounds typically lasted for hours, often with an entourage of 8-12 people. When we walked onto a hospital floor, the house staff would join us to listen. I thought it was strange that so many would be interested in heart failure. And so, I asked one young physician: are you interested in cardiology? The answer: Not at all. I just like to listen to the way you tell stories and how you make really sick patients smile.

Comedy plays an essential role in medicine, whether you are a patient or a practitioner, and no matter if you are talking to patients or giving an academic presentation.

My love of comedy proved useful decades later, when I was involved in a "Grand Debate" sponsored by the Heart Failure Association in Vienna in 2018. As everyone knows, debates are not entirely won or lost by scientific content. Debaters win over their audience by their sense of humor. The room was filled with several thousand people, and when my opponent finished his talk, it was my turn at the podium. I had planned on a very persuasive (and entertaining) presentation.

But when I clicked on the screen to bring up my first slide, nothing happened. The system had suddenly crashed, and I was standing at the podium with nothing to show. The technical staff wondered if I could ad lib until they could reboot the system.

I asked: How long do I need to keep the audience engaged? The answer: We do not know. It could be anywhere between 10 and 20 minutes. But you need to keep talking. If we take a break, we will lose the audience. And when the system starts working again, you need to go immediately into your presentation.

How was I going to keep the audience fully engaged for an undefined period of time, potentially lasting 10 to 20 minutes?

Memories of being a stand-up comedian 50 years before flooded my brain. My instincts were still there.

So, I began: "I want to tell you a story that many of you think you might have heard before. It is about a kingdom long ago, and a king who is interested in sponsoring a contest as to who would win the hand of his daughter, the princess, in marriage."

The audience erupted in laughter. I planned to take the threads of a traditional fairy tale, modernize it, and make it pertinent to cardiology. But I needed to speak really slowly, because I had no idea where the story was going. I was making it up on the spot. And every line needed to be funny.

By some miracle, the story worked. And amazingly, just as I was running out of material, the system started working again. The duration of my totally unplanned stand-up comic routine: 18 minutes. Eighteen incredibly long minutes.

For years since that meeting, people still come up to me and tell me how memorable the debate was for them.

I ask: What argument did you like the most? What was most convincing?

The answer: I don't remember anything about the content of the debate. I just remember the fairy tale you told when the slide system failed. You kept the audience laughing for a long time.

From a comedic viewpoint, it has all been downhill for me ever since. But if this story made you smile or laugh just a bit, that was the whole point.

Disclosures

During the past 3 years, Packer has consulted for Abbvie, Actavis, Amarin, Amgen, AstraZeneca, Boehringer Ingelheim, Caladrius, Casana, CSL Behring, Cytokinetics, Imara, Lilly, Moderna, Novartis, Reata, Relypsa, and Salamandra. These activities are related to the design and execution of clinical trials for the development of new drugs. He has no current or planned financial relationships related to the development or use of SGLT2 inhibitors or neprilysin inhibition. He does not give presentations to physicians that are sponsored by industry.