Personal views: Clowning in hospitals is no joke
Authors: Caroline Simonds
Journal: BMJ (1999)

The 28 members of Le Rire Medecin (Laughing Doctors) have worked closely with hospital medical staff in France since 1991. Twice a week the group holds specially conceived shows for children and their families in paediatric wards in eight hospitals—six in Paris. Each year it performs for more than 30 000 children, a similar number of parents, and more than 60 000 medical personnel.

The group fills a gap left by other hospital activities carried out by teachers and volunteer workers and provides a vital part of the effort to humanise the care of children.


To our knowledge the only other groups which perform a similar function are The Big Apple Circus Clown Unit in New York, the Doutores da Alegeria in Brazil, and Die Clownen Doctors in Germany. 


The group fills a gap left by other hospital activities



By 1993 we decided that with the emergence of other groups it was important to define the basic principles of our work and to create some rules for clowns performing in hospitals. Le Rire Medecin already had projects for training performers, but one of the dilemmas for artists working in a hospital is the question of confidentiality. Is it necessary for a clown to know if a child is in pain, has been molested, or has an incurable illness? Experience has taught us that to remain sensitive to each patient it is important for performers to modify their gestures or physical distance from a patient and even to question the choice of a song. We also need to have the trust of the medical team in order to work on a long term basis with their patients.

We studied other codes, numerous guides, and various sets of rules. Some we ignored, some inspired us, and some we transformed. We wanted a living document that could be modified by other groups of artists and adapted to other cultures. Would other groups bother to apply our principles? How could we control the quality of their work? How could we guide other artists working in hospitals to work honestly? We decided that we needed to define the difference between a “walk around” clown job, family entertainment, and in depth work interacting with a medical team.

The first draft of the code was draconian and the reaction to it was varied. Those who already practised under a professional code—physical therapists, nurses, and doctors—were reassured and at ease with our code. The others—clowns, administrators, and teachers—were worried that such a document would block the creative drive of artists and that it was following the obsession of being politically correct.


For example, in a paediatric ward with seriously ill children it is important that the usual creative process of an artist or clown should be respected while he or she is required to obey a few basic principles. There are 11 basic articles in Le Rire Medecin’s code. They define standards of professionalism, boundaries of artistic expression, limits of the creative role, responsibility of each artistic act, respect for patients as well as health care workers, privacy, emotional parameters and distance from patients, basic safety, and even hygiene. 




Most of the clowns who have worked with Le Rire Medecin for eight years think that the code has provided them with a framework which frees them to create. We hope to maintain a policy of professional discipline and honest craftsmanship. This requires frequent self evaluation and dialogue with the hospital staff. We would never have been able to accomplish the quality clowning that we have without the support and good will provided by the medical staff. They have given us our place in their world that traditionally provides little room for new disciplines.

After all, what a provocative job it is to be the funny one in such serious places as hospitals.