Patients may prefer professionalism over humor for urologic care

In this interview, Max D. Sandler discusses the study, “Prospective Patient Preferences for Humor in Urologists Treating Erectile Dysfunction: A Survey Study,”¹ for which he served as the lead author. Sandler is a third-year medical student at the University of Miami Miller School of Medicine in Miami, Florida.

Max D. Sandler

Could you describe the background and rationale for this study?

First, I just wanted to thank you for the opportunity to speak with you today. At least in my experience, urologists tend to be some of the funniest and most approachable physicians in the hospital. So, I thought it would be interesting to see how those traits made patients feel, especially for patients who might have a stigmatized condition like erectile dysfunction. Unfortunately, there's not a lot of research on humor. It's hard to standardize, so it's hard to study. I couldn't find that much literature out there, but I was able to find one study by an author named [Elisabeth] Sartoretti, and they found that women who received a funny business card during a routine mammogram screening tended to remember the radiologist's name better, they tended to rate the encounter as more positive overall. That's the background that helped guide me when I started thinking about how I wanted to do this project.

What were the key findings?

We created 5 pairs of mock business cards. They business cards were physician business cards. In each pair, one was a humorous card, and one was a professional card. The funny card alluded to erections. For example, one had a symbol of a diamond and the caption was "harder is better" on the business card, while the professional card just advertised expertise in health care, and didn't really mention ED. We posted an anonymous survey online to a website where respondents completed short tasks like surveys. Our survey asked them to imagine that they had erectile dysfunction and they’re seeking a urologist to help them. Then they were asked which urologist they'd rather see based on the business cards of Dr. Smith or Dr. Jones, which were just the names that we assigned to the funny or the professional business card in each question. Respondents were able to pick either Dr. Smith or Dr. Jones, or “I wouldn't care if I saw either urologist”, or “neither”––they don't want to see either of them.

We had almost 1000 participants. The results showed a preference for the professional card in almost all questions. Across the whole survey, an average of 66% preferred the professional card. The highest rate of selection of the humorous card in a single question was only 38.4%. Honestly, it was a bit of a surprise to us. We had a suspicion that participants would enjoy or appreciate a little bit of humor. We thought maybe it'd be more enjoyable for participants to seek out a physician who embraces humor, which would be similar to the results of the radiology study that I mentioned earlier. But something to keep in mind is that the participants in our study were prospective patients. So, they might not really have erectile dysfunction. They were completing tasks online and they were being compensated, so efficiency might be a goal of theirs. We thought maybe they might have seen this as a medical themed survey, so, they might have just chosen a professional card due to medicine's inherent ties to expertise. We think that the results of this study [might] be pretty different if it was conducted in a real clinic [with] real patients who actually have a stigmatized condition like erectile dysfunction, because they feel a stigma. People with a stigma may better appreciate humor to break the ice and create a trustworthy atmosphere with physicians.

Is there any future work planned based off of this study?

There's a lot of room to study these kinds of things. Future work could look at the impact of humor on patient choices in a real-world office setting. Our study, I believe, tilted in the direction of younger people who were using this website. If we conducted a study in real life where they were in a clinic, where we are examining men who are typically a little bit older, that would be an idea that someone could have for study about this. I think we're just starting to understand, at least with our study, how you can even study humor. There's definitely an avenue to do that. I don't have anything planned at the moment, but I really liked working on this study and I could see myself continuing to do something in the future.

What are the key take-home messages for urologists based on these findings?

The take-home message based on our study is that professionalism is important in men's health, especially for a sensitive condition like erectile dysfunction. Stigma is a very real and large barrier for patients to take that leap and finally make an appointment with an expert. Finding ways to lessen that apprehension that some people might have about seeking care for their condition is really valuable. While our results may imply that a strict all-business professionalism is superior, I think it's important to acknowledge that humor is really subjective. Because of that, it's really hard to study. Again, future work should look at the impact of humor on choices in real-world health care settings, choices that patients could make with or without humor in the encounter.

Is there anything else you wanted to add?

I think our study is a start to learning how to add to this evolving repertoire of tools that physicians have to reduce stigma and facilitate discussions on these really sensitive topics. There's definitely more work that could be done on finding out if urology patients prefer funny urologists.

Reference

1. Sandler MD, Egemba C, Dubin JM, et al. Prospective patient preferences for humor in urologists treating erectile dysfunction: A survey study. Cureus. 2024;16(3):e55637. doi:10.7759/cureus.55637