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Humour me, doctor
Clowns traditionally play the fool, but in a medical setting they can have a powerful influence on the wellbeing of patients and their families, writes Sam Lawry.
Two clowns are livening up an adolescent ward in the Royal Children’s Hospital, jesting with the young patients. A doctor enters the room and the clowns stop, ready to step back and allow the doctor to do his work. But the doctor takes a seat, smiles and says, “Carry on!”
This short exchange reflects a subtle shift in perception of what constitutes "work" in a hospital setting. This is art within health. Reflecting on this change in his twelve years as a clown doctor, David Symons, AKA Dr Tickle, says, “It takes a while for people to understand…our greatest fans were skeptics in the beginning. Our method is through play, creating a good psychosocial environment. We are supporters of the spirit.”
Australian clown doctors – what overseas may be called dream doctors, hospital or medical clowns – are professional performers, trained to work in hospitals alongside health professionals. This training includes very thorough protocols on conduct in the healthcare setting, including infection control, supervision and debriefing processes and a limit on shifts worked per week. A typical shift may include two hours in the morning of wards and clinics and then two hours in the afternoon of clinic and emergency. This could include day surgery, dialysis, oncology – each day is different depending on what requests are made and who there is to see. Working in pairs, the clown doctors check in with nursing staff and review the communication book in the hospital: “Dr Fairyfloss and Dr Knowitall visited today; Ben had X, needs Y today”.
“We really honour and respect the work doctors do,” says Symons. “We are not there to cure…but to bring an imaginative element or exchange. We can also give children a sense of control – they can tell us to go away, or they can choose whether to be an observer or participant.
“Their circumstances are so compelling, but we can provide such relief…in the burns unit, for example, children often must come again and again, there is lots of emotion around those injuries. We help ease their experience. It is a lovely thing about being in the performance mode, we have a job to do and we can make it better, offer something. Sometimes children don’t laugh for days…and then we come in.”
Trained performers bring a particularly attunement and sensitivity, valuable in an environment where circumstances can change very quickly and emotions are heightened. “We see the most heartbreaking moments – where a parent knows the extent of a child’s injuries and the child doesn’t, where that parent tries to maintain a sense of dignity…so every moment of joy, or laughter, becomes more precious. This is where art comes into the medical world.”
Through the Humour Foundation, a charity, 55 clown doctors work their magic across Australia, with programs in all major children’s hospitals, as well as in general hospitals, hospices and palliative care. There has also been clown doctor outreach, to East Timor and Afghanistan.
The foundation’s co-founders, Jean Paul Bell and Dr Peter Spitzer (AKA Dr Fruitloop) first met in London. Bell was a professional mime and Dr Spitzer had trained in the performing arts whilst completing his studies in medicine. Fascinated by the ‘art of medicine’, and inspired by a meeting with legendary humour doctor Patch Adams in 1993, they formed the foundation in 1996. Their idea was to take performers offstage and to the bedside of patients.
Dr Spitzer explains the model: “Where possible we look for brief interventions that allow time for play. This enhances compliance, as well as relationships. People have raised concerns. But we have been modelling for the past 15 years that it is ok to be funny, and this has enhanced our relationship. We initially learnt some interesting lessons in rejection. It was felt we didn’t have a place, that there was no background for us. People think “clown” and they think “Bozo the clown”…some people find this scary. But we have little make-up. We wear a schnoz, a white coat with appliqués and magic pockets. Each clown doctor has their own persona.”
Dr Spitzer was granted a Churchill Fellowship in 2002, to study the impact of clown doctor programs in other countries, and he has an abiding interest in research on humour therapy. Drawing on its recent work in aged care and dementia, the Humour Foundation obtained funding from the NH&MRC to conduct a three-year SMILE research project, which has just been completed. This is the world’s first large-scale study evaluating the impact of humour therapy on older patients and carer staff, using a performer and a health care staff member (the Laughter Boss) working together. Now Dr Spitzer is looking forward to the results.
Research into humour and the effect of laughter shows positive signs: reduced serum cortisol levels, lowered stress, even pain relief. Yet while there has been a long history of jesters, or fools, in serious contexts (such as royal courts), and an element of performance or ritual in the practice of some medicine (such as by shaman, or traditional medicine men) medical clowning has only in more recent years gained wider acceptance. Recently the University of Haifa in Israel launched a three-year medical clowning degree, incorporating training in health with that of improv and clowning.
There is a growing recognition that the interaction between the clown doctor and the patient can open the door to communication, creating space in a stress-filled situation that can allows health professionals to work effectively.
“The kids are laughing, the memory of their pain is lessened, parents are therefore less stressed and more open. For instance, because patients and their families are relaxed we may find the vein the first time. We accompany children to the operating suite, and get referrals to work in intensive care.”
Transformations in spirit can occur, explains Dr Spitzer. ”We love it when we two clowns get into a lift, and then a couple of consultants get in. They may be very serious…but by the time the lift door opens again there is music, bubbles, smiles. This creates quite a scene, and envelops people waiting for the lift.”
The foundation relies solely on fundraising and donations. The GFC and recent events have had an effect, meaning less frequent hospital visits. “Our commonest question now is: ‘Why aren’t you here more often?’ It is an interesting turnaround. The arts and play are more present; we are working with the medical system.”
“Each day is different. It stimulates the intellect and touches the heart.” It is this duality that keeps Dr Spitzer engaged in the humour work as well as his general practice, and that ensures that the performance artists who work with the program want to stay on, brightening the days of those they work with, and alongside, too.
This article appeared in the May 2011 edition of vicdoc.
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