Laughter is regarded as an interactional device in conversations and it is an important element in human communication. When interactants have a mutual understanding of the situation at hand laughter occurs (Coser, 1959). People can laugh to shorten the distance, express friendliness and also express joy. People can also
laugh to deal with awkward or sensitive moments. Doctor-patient interactions are usually regarded as serious contexts and laughter is the best lubricant (Chafe, 2001),
especially when encountering embarrassing moments and uncontrollable problems (Francis, Monahan, & Berger, 1999). Researchers devoted to analyzing the functions
(Baker et al., 1997; Partington, 2006; Stewart, 1995), the types (Beck, 1997; Sayre,2001), or the interactive organization of laughter (Glenn, 2003; Haakana, 2001;
Osvaldsson, 2004). Despite this abundant research, few of them inspect how laughter affects the doctor-patient interaction. Thus, the current research examines the effect of laughter on doctor-patient interaction in both quantitative and qualitative approaches.
The participants in the research include 18 physicians (an average of 33 years old) and 55 elderly patients (an average of 74 years old) on the patients’ first visit to a teaching hospital in southern Taiwan. The identification of laughter is based on the intuition of an “ordinary person” to identify “audible sound” that can be “regarded as laughter” in an interaction (Bachorowski, Smoski and Owren, 2001, p.1582). I separated each consultation into opening and post-opening stages and the doctor’s first medical related question (such as “a li kin-a-jit si an-na? / What’s your problem today?”) is
used as the boundary of the two stages.
The present study applied both macro and micro analyses of the effect of laughter on the doctor-patient interaction. In the macro analysis, I observed the effect of opening stage laughter on the amount and timing of the post-opening stage laughter. (1) Within consultations with opening stage laughter, the instances of post-opening
stage laughter (18.9 instances) were more than those without opening stage laughter (11.1 instances). (2) The first post-opening stage laughter accelerated when opening
stage laughter occurred (140 seconds when with laughter versus 250 seconds when without laughter). One explanation for the increased instances of laughter and accelerated timing of laughter is that the occurrence of opening stage laughter mitigates the seriousness of medical consultations and sets a lighter and joyful framing of the interactions at hand. Thus, the post-opening stage laughter occurs more often and earlier.
In the micro analysis, I inspected the effect of opening stage laughter on the immediate stage by observing the degree of patient participation. Tsai (2005) observed
that doctors’ use of situational greetings (such as “li ma-king e lang hioo?/Wooh! You are from Ma-king City?”) elicited more patient participation than using general
greetings (such as “li ho/ How are you?”). In view of the effect of doctors' greeting expressions on patient participation, I examined the relationship among the
occurrence of opening stage laughter, doctors’ greeting expressions, and patient participation. The patients’ verbal activity can be regarded as an agent of patient
participation and through calculation of the amount of the patients’ verbal activity one can evaluate the patients’ degree of involvement and participation (Ishikawa et al.,2005). (3) The occurrence of opening stage laughter was positively related to the average amount of patient syllables (5.9 syllables when without laughter versus 52.5
syllables when with laughter). (4) In the situational greeting pattern, those with laughter contained a higher amount of patient syllables (61.1 syllables) than those
without laughter (26.8 syllables). The present results prove that doctors’ greeting expressions and the occurrence of opening stage laughter both have a positive effect on the degree of patient participation. When doctors use situational greeting patterns with patients, the patients tend to be more forthcoming and the probability of the occurrence of laughter increases and doctors may gain more first-hand information
I also incorporated the qualitative analysis to observe the interactional contexts in which laughter commonly co-occurs. (5) When tackling sensitive topics (death issues,
cultural related issues, medical issues, or health behavior issues) or activities (correction and acknowledgement), laughter usually occurred. The common
characteristic of these topics and activities is that they are the possible contexts of face threat and thus laughter becomes an effective device in mitigating the threats to
doctors and patients. In that, I suggest doctors use situational greeting patterns, which can elicit more patient participation and also increase the possibility of laughter in both opening and post-opening stages, and use laughter as a resource for dealing with sensitive and delicate issues in consultations.
|Date of Award||2008|
|Supervisor||Mei-Hui Tsai (Supervisor)|