Asymmetrical Laughter by a Provider Erodes Trust

be heard as being laughable, as being

not believable.

Kerby’s recounted incidents of providers laughing at his troubles—waiting overly long in an uncomfortable situation for a procedure and voicing a worry about a sensation while on a new medication—were instances of asymmetrical provider laughter at another’s troubles. For Kerby, such laughter brings to mind his earliest experiences of being laughed at and not believed. Perhaps particularly patients with rheumatic disease, many of whom have endured months or years of diagnostic delay, may be likely to interpret asym­metrical laughter as another sign of disbelief.

The cultural myth of medical miracles suggests that medications and technology are the core of medical practice. But rheumatologists and their patients know the core of medical practice is trust.

Rheumatologists need their patients to trust them to provide the best currently available care so that patients remain adherent to prescriptions that can prevent further damage.

Patients need their physicians to believe them when they describe even preposterous-

sounding sensations. They need their pro­viders to not leave them in uncomfortable or laughable situations. Patients need their providers to strive not to unwittingly laugh at their troubles.

Laughter has the power to break hard-won trust in an instant. Kerby has not gone to see a rheumatologist in four years now.

M. Cameron Hay, PhD, is a medical anthropologist who has been conducting research with rheumatology patients and rheumatologists for more than 15 years. She is a professor in and chair of the Department of Anthropology at Miami University, Oxford, Ohio.

Kerby Hyland is a citizen scientist who possesses a lifetime of experience with autoimmune disease. He has spent more than 20 years working with physicians and researchers in their efforts to find answers to the complex issues of autoimmune arthritis.

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