Clowning around: Understanding the role of clown doctors at the Royal Children’s Hospital Melbourne (RCH)

Abstract

Introduction: Clown doctors are a feature in paediatric hospitals, visiting children and families, providing a welcome escape from the reality of hospitalisation. Whilst the use of humour to improve health and wellbeing has been widely researched, limited exploration of the role of clown doctors has occurred. This research aims to elucidate the role of clown doctors within a paediatric hospital. Theory/Methods: In this ethnographic study, participants included the clown doctors and every person with whom they had a meaningful encounter. The narrative of the clown doctors was captured through 1,500 hours of participant observation documented over one year. Interviews and visual methods were utilised, with key informants drawing and explaining their experience of the clown doctors. A constructivist framework was used to analyse emergent themes. Results: Whilst almost universally acknowledged as a positive addition to the hospital, most people who encounter the clown doctors have little conception about the scope of their role. Themes that arose during observation that related to the function of clown doctors included: distraction, anxiety reduction and procedural assistance; entertainment and making people laugh; emotional support and providing comfort; and communication, including translating clinical information to families. These functional elements of the clown doctors are the result of a more complex, intimate human connection that arose due to the nature of the clown being low-status, open, and vulnerable, and in particular existing as an outsider within the medical establishment. These interconnected relationships drove engagement and resulted in clown doctors becoming privy to information, emotions, complaints, jokes, disclosures etc., often not revealed by patients and their families to staff members, or even vice versa. Discussion: While almost universally acknowledged as a positive addition to the hospital, most people who encounter the clown doctors have little conception about the scope of their role. The role of the clown doctors transcends traditional labels, but in crude terms it can be characterised as thus: role leads to function, which in turn leads to outcome. In terms of a joke analogy, function is the punch line of being a clown doctor. Conclusion: The results of this study provide a comprehensive understanding of clown doctors and the complexity of human relationships within a major paediatric hospital, uncovering a profound, nuanced culture cheerfully highlighting the need for a more person-centred approach to healthcare. Lessons Learned: This study has advanced understanding regarding clown doctors' unique contribution to healthcare delivery within a tertiary paediatric health service, highlighting their expertise in role-modelling person-centred interactions. Limitations: This study was conducted within one paediatric health service. The researchers believe however that the novel understandings regarding the role of the clown doctors generated through this study would likely transfer easily to other healthcare settings. Suggestions for Future Research: This study will inform future qualitative and quantitate research studies that aim to describe and measure the role of the clown doctors, as distinct from their activities, and the contribution this has to the experience of patients within health care services.