This investigation revealed that humorous elements in communication enhance the patient’s wellbeing during routine breast cancer screening. Patients in the humor group rated the importance of the discussion with the radiologist higher (p < 0.05) and were able to better recall the radiologist’s name (p < 0.05). Patients considered a humorous doctor more empathetic (p < 0.05). We observed a trend towards less anxiety in patients exposed to humor during their examinations (p = 0.166), without reaching statistical significance. The physician’s competence was rated higher by the humor group, just below statistical significance (p = 0.09). There are many reasons to dispense with humor as a physician. Our data show that a physician who uses humor in communicating with the patient has no reason to be concerned about appearing incompetent.

In traditional medical settings, radiologists are invisible to patients and physicians. In one study, patients were asked about their concept of the radiologist’s task and frequently answered, “That’s the guy who always asks me if I have an allergy” [15]. Many patients are unaware of the radiologist’s role, who then remains largely invisible to patients [10].

Radiologists must be aware, that patients experience stress reactions and anxiety in a radiology department, mainly because they fear the outcome of the radiological investigation [16, 17].

Far from making the radiologist an object of ridicule, our aim is to ensure that radiologists, despite their technical expertise, can help patients feel more comfortable, improve the patient’s rating of the doctor-patient discussion, and reduce the patient’s anxiety during a radiological examination. Many studies, largely outside the medical sector, have shown that humor is an excellent coping strategy for patients. It is well known that patient’s mental wellbeing can be enhanced significantly by humor and empathy [18]. In this context, it must be mentioned that there are extremely different techniques of humor [19].

The radiologist’s role in the clinical setting is a subject of ongoing discussion, because techniques such as teleradiology or artificial intelligence will bring about major changes in the coming decades [6, 9, 12, 13, 20,21,22,23,24,25,26,27,28,29,30,31]. Should the radiologist serve exclusively as an “imager” in a dimmed room or should he/she be a patient-oriented physician in the health care management system?

Evidently, empathetic patient care is one way of showing patients that radiologists are more than persons who press buttons and ask patients if they have an allergy. Humor can be used as a means of alleviating the patient’s fear and anxiety, and assist the radiologist in leaving a stronger impression on patients than other doctors although the radiologist does not visit the patient daily at the bedside.

Humor has been a well-known factor in medicine, but research on the subject is scarce. Psychological carriers of humor are numerous. Patients usually perceive these as amusing and not ridiculous. In this context, it is interesting to note that advertisements for radiological positions often mention that people are preferred with social skills and a sense of humor can certainly be considered part of one’s social skills [32]. One of the most powerful psychological triggers of humor is surprise [33, 34].

In this investigation surprise was used when patients came in for breast center screening examinations. For decades, radiologists have entered a semi-darkened investigation room. Now, for the first time, a radiologist says, “Your examination is fine but there is one little problem: patients cannot remember the radiologist’s name.” Now the patient expects a regular business card. However, patients in group 1 (“humor”) receive a comic-like drawing on the doctor’s business card (Figs. 2 and 3). The patient experiences relief because the outcome of the investigation was no cause of concern, but is also confronted with an incongruous and surprising situation. This standardized approach was enough to lessen the patient’s anxiety, enhance wellbeing, and strengthen the doctor’s empathy.

Schematic Diagram of how patients are greeted in group 1, part 1. First, the participant is told that the examination does not reveal any change. Up to this point, both groups were treated in the same manner

Schematic Diagram of how patients are greeted in group 1, part 2. Now the participants in group 1 receive a business card with humorous elements, but with the same information (name, academic title, phone number, mail address) as group 2. The perceivable change in the manner of greeting introduced an element of surprise, accompanied in most cases by laughter

The fact that patients are better able to recall the radiologist’s name when given a card was recently addressed in a similar study [12].

It should be noted that the practice of treating patients with and without humor is an element of our clinical routine. Therefore, the radiologists at our institution are well trained in this type of patient care. Based on the outcome of the present investigation, we recommend a similar patient care strategy at all radiology departments.

Using humor systemically without using psychological backgrounds should be used with caution. We would like to mention that in literature there are people who can react very negatively and irritated to humor. Such irritation can be caused by a clinical phenomenon called gelotophobia, that is said to affect about 5% of the population [35]. We were prepared for this, but have had consistently good experiences in the humor group in this study and in daily routine. As we adhered to the carriers of incongruity and surprise rather than jokes, we encountered no negative feedback. Only one patient in the humor group was disturbed by the telephone call, declined to give any information, and was excluded from the analysis.

This study encourages us to continue research in the field of communication and radiology. But this does not only apply to radiologists. With similar approaches, we see great opportunities to improve communication in other clinical disciplines.

This study has the following limitations. Firstly, it was a single- center study. Trials involving larger patient numbers might yield different results. As this issue concerns all medical specialties, further research is essential. Secondly, only patients with BI-RADS 1 and 2 were included. It would be interesting to investigate whether patients with more serious diseases would also respond as well. Third, humor can be expressed by various means. We used a humorous calling card. Other forms of humorous introductions could also be investigated. Fourth, human relationships are not easily standardized. Physicians have different personalities. We believe that health care professionals should be trained in the use of humor, and larger studies should be performed to determine whether humor enhances patient wellbeing. Humor can be trained and contributes to life satisfaction and health [19]. Considering the increasing rates of depression among physicians, this would be an interesting prophylaxis for the future and further research is needed concerning this topic.