Humour in paediatrics

Abstract

Earlier this year I was in Perth, examining for the Fellow of the Royal Australasian College of Physicians clinical examination. I know that the mention of the clinical exam causes a shudder to run through the entire collective consciousness of Australasian paediatrics. All paediatricians remember every minute and every murmur of their clinical exam(s), whether it was 30 or more years ago like mine, or a very recent pleasure. I have to tell you, though, that being a college examiner has been a rewarding and enriching experience, which I recommend to all of you. It has improved my clinical skills, albeit starting from a very low baseline, exposed me to heart-rending stories from the parents of children with inconceivably ghastly conditions and given me the joy of interacting with hugely talented colleagues, many of whom have become lifelong friends. But I digress, as usual. We had been examining all day and the examiners met in a restaurant for dinner. One examiner was accompanied by his wife, a professor of gynaecology. The paediatricians discussed at length the strategies we adopted to cope with fractious children in the exam to try to get them amenable to being examined by four candidates. A couple of us said we tried to use humour to cajole the children, and gave examples. A Melbourne paediatrician mentioned a courageously honest and engaging article written by a paediatric colleague, Michael Harari, in which he described how he adopted unashamedly silly behaviour to engage his paediatric patients (see http://www.racgp.org.au/afp/200806/200806harari.pdf).1 At the end of the evening, I apologised to the professor of gynaecology for talking shop. She said no, she had found it extraordinarily touching to hear how paediatricians try to win children round and how much we obviously cared about the children. Michael's article is a description of a paediatrician who is not afraid to admit of making a fool of himself for the sake of a good rapport. This is the very heart-throb of paediatrics, it is what keeps paediatricians young and vibrant. Paediatricians cannot afford to be pompous. Children brook no nonsense. My mother tells a story of working as a junior doctor in paediatrics in Sheffield in the 1940s. The legendary Ronald Illingworth was leading a huge ward round of white-coated doctors and uniformed nurses. Illingworth stopped at the bed of a 2 year old. ‘What's wrong with you?’ he asked. ‘ppendix’, said the child. ‘So you're better now, are you?’ asked Illingworth, kindly. ‘Too fookin' right, I am’, came the brazen reply. Is there any evidence that humour is good for children? For a long time, the only scientific study of humour showed that making children laugh elevated their secretory immunoglobulin A levels.2 Why anyone would have thought of measuring secretory immunoglobulin A after making children laugh is a mystery. However, a more recent randomised controlled trial has shown that children exposed to clown doctors before heart surgery were less anxious than control children.3 It is good to have evidence. Now let us be paediatricians, enjoy our patients and our colleagues, and keep telling those bad jokes. The Victorian bush fires of 2009 The past and present Editors of the Journal of Paediatrics & Child Health express their heartfelt sympathy to all those affected by the devastating Victorian bush fires of 2009. We think of those who lost loved ones in the fires and those whose loved ones remain in mortal danger. We think of all those people who have been scarred physically or emotionally by the fires, and we wish them a speedy recovery. We think of the children, those who died, those recovering from burns, those who lost parents and siblings, relatives and friends, houses and possessions. We recognise how traumatic the terrifying fires have been and still are for children, and recognise the efforts of health care workers, family and friends to help children cope with the trauma. We think, too, of the courage and heroism of many ordinary people caught in the fires, and also the heroic actions of fire fighters, volunteers and health care workers, all of whom have had to cope with the trauma themselves. We share with pride the generosity of the Australian people and those from overseas as they rally with financial and emotional support for those who have survived this awful natural disaster. Out of adversity, strength can come. David Isaacs, Frank Oberklaid, Spencer Beasley, Mike South, David Tudehope