All the world’s a stage, according to the bard, and your consultation room is no exception
All the world’s a stage, according to the bard, and your consultation room is no exception
When thinking about applying marketing thinking to general practice, there are two things to consider.
One is treating your practice as a “servicescape”, where every physical element of your practice is designed to project an impression of friendliness, trustworthiness and confidence.
The other relates to the GP visit as a theatre performance, with front and backstage activities working together to provide an immersive show, or experience, for your patients.
These two elements really come together in one area of the practice: the consulting room. While the waiting room sets the scene for a successful service encounter, the consulting room is where you have the most impact on your patient.
How you look, how your room looks, what you say and how you say it all have a huge influence on whether or not your patient will engage with you to explore and hopefully solve their health dilemma.
So what are the elements of good medical theatre?
Costuming
Whether we like it or not, research shows that appearance can affect the level of trust doctors achieve with their patients. A number of studies indicate that professional dress – smart, conservative outfits – increase trust and build confidence among patients.
Evidence shows patients feel more comfortable discussing psychological, sexual and personal matters, are more adherent to prescribed therapy, and more likely to return for follow-up, if their GP is professionally dressed.
A full suit (and tie for men) isn’t necessary, but jeans and sneakers don’t cut it. There is no clear advice regarding beards and moustaches for men or jewellery for women, so the assumption is that well-trimmed facial hair and adornments that aren’t too flashy are OK.
The evidence about white coats is a lot less clear. On the one hand, this science-based identifier that has helped doctors differentiate themselves from quacks and fakes since the late 19th century, is the most common symbol denoting someone as a doctor (followed closely by a stethoscope around the neck).
But since the late 1980s, a growing body of studies advised that doctors should ditch their white coats for a wide variety of reasons, from too many other health professionals adopting white coats and confusing patients, to the increased threat of spreading nosocomial infections.
One US infectious disease specialist, Philip Lederer, is even trying to launch an international movement to ban white coats in all settings, although they seem to have largely disappeared in Australia.
So, Why should dress matter? Isn’t it all about professional competence? As one group of Italian researchers say: “Dressing for the role does not cover up a lack of professionalism, but complements and completes it.”
Props
As mentioned above, the stethoscope is a medical symbol nearly as powerful as the white coat. A study by Curtin University’s Health Innovation Research Institute found that to increase patients’ trust, doctors should wear a stethoscope and surround themselves with medical instruments. One of the researchers was quoted as saying, “We remember the stethoscope being put on our chest as a child and we associate that with the benevolent, kind person who gave you the medicine and made you better.”
The layout of furniture in consulting rooms is also important. The evidence is overwhelmingly in favour of setting your desk in a position where patients sit next to the doctor, rather than having the desk between them.
Sitting side-by-side increases the sense of partnership between patient and doctor because you’re sharing your desk with them. Some suggest using a simple device such as a box of tissues to show where their part of the desk ends and yours begins.
Nearly every GP’s desk has a computer, and the general consensus is that the screen should be angled away from the patient and towards the doctor, allowing you to have control over the information on the computer, but share information when appropriate.
The script
What you say to patients and how you say it could be the subject of a whole article – or an entire book, for that matter. But in brief, there are a few key (and sometimes contradictory) styles of communication that studies show are most effective in building trust, confidence and adherence:
DIRECTING – An authoritative, directing style leads to higher levels of patient satisfaction, particularly when giving a prescription or dealing with physical illness, as opposed to mental illness.
EMPATHISING – When giving patients bad news, this style allows doctors to both explain the facts clearly and be emotionally responsive. A growing body of literature recommends method acting classes for medical students to develop their “‘empathetic imagination” – the ability to show they can put themselves in their patients’ shoes.
EXPLAINING – Since patients often have trouble focusing on the details once they have been given a top-level diagnosis, it helps to break information up into logical categories to increase the chance they’ll remember it. A seminal article by Ley et al in Psychological Medicine back in 1973 outlined this as the doctor saying to his/her patient, “I am going to tell you:
- What is wrong with you;
- What tests we are going to carry out;
- What I think will happen to you;
- What treatment you will need; and
- What you must do to help yourself.”
Thinking of your consultation room as a stage, and your patient encounter as a performance can sound like you’re not taking your job as a health professional seriously, but it actually means you are deadly serious in your quest for patient-centred care.
Giving your patients a good show means achieving the best holistic outcome.
