Granek-Catarivas M, Goldstein-Ferber S, Azuri Y, Vinker S, Kahan E
Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Postgrad Med J. 2005 Feb;81(952):126-30. doi: 10.1136/pgmj.2004.019406.
(1) To explore the frequency with which humorous behaviour and statements occur in family medicine practice in Israel, and (2) to quantitatively assess the correlation between the subjective perceptions of humour in medical encounters between patients and physicians.
In a cross sectional study, two populations (doctors and patients) were surveyed with paired structured questionnaires completed immediately after primary care practice visits. Two hundred and fifty consecutive encounters from 15 practices were sampled. The physician questionnaire was self administered, and patient questionnaire was administered by a trained research assistant.
A mean of 16.7 questionnaires was completed per physician (range 6-20). The physicians reported having used some humour in only 95 encounters (38%), whereas almost 60% of patients agreed with the statement, "The doctor used some humour during the visit". At the same time, for specific encounters, the agreement between patients' perception and physicians' perceptions on the use of humour, although not completely by chance (p = 0.04), is low (kappa = 0.115). Patient characteristics (age, education, gender, family status, mother tongue, self perceived heath status, stress, mood, and expectations) were not related to the degree of agreement between the patients' and physicians' perceptions.
Humour was used in a large proportion of encounters, independently of patient characteristics. Patients seem to be more sensitised to humour than physicians, probably because of their high stress level during medical encounters. Cultural differences may also play a part. Physicians should be made aware of this magnifying effect, and the issue should be discussed in medical schools.
（1）探究以色列家庭医疗实践中幽默行为和言论出现的频率，以及（2）定量评估患者与医生医疗接触中幽默主观认知之间的相关性。
在一项横断面研究中，对两组人群（医生和患者）进行调查，在初级医疗实践就诊后立即完成配对的结构化问卷。从15家医疗机构中抽取250次连续的医疗接触。医生问卷由医生自行填写，患者问卷由经过培训的研究助理进行填写。
每位医生平均完成16.7份问卷（范围为6 - 20份）。医生报告仅在95次医疗接触中使用了一些幽默（38%），而近60%的患者同意“医生在就诊过程中使用了一些幽默”这一说法。同时，对于特定的医疗接触，患者和医生在幽默使用认知上的一致性虽然并非完全偶然（p = 0.04），但较低（kappa = 0.115）。患者特征（年龄、教育程度、性别、家庭状况、母语、自我感知的健康状况、压力、情绪和期望）与患者和医生认知的一致程度无关。
在很大比例的医疗接触中使用了幽默，且与患者特征无关。患者似乎比医生对幽默更敏感，可能是因为他们在医疗接触期间压力水平较高。文化差异也可能起作用。应让医生意识到这种放大效应，并且该问题应在医学院校中进行讨论。
