Whereas practice building and management courses teach a great many things, one factor that could account for your success or failure in practice is right under your nose -- your smile. Can you answer "yes" to such questions as: Is your smile natural? Does your smile accurately represent what you feel? How do you think your patients and staff would rate your smile?
Tomorrow, ask your nurse or an associate to comment on how you answered these questions. See whether their perception of your smile agrees with your own. While the human smile does express friendly intent ranging from slight submission to readiness for contact, universally there are some intracultural and cross-cultural exceptions. Non-verbal expert Ray Birdwhistell reports that middle-class people from Ohio, Indiana, and Illinois smile much more than people from New England, and that New Englanders think they are more reserved because they don't smile. The Japanese, by comparison, do not associate smiling with good humor or a friendly attitude, but, rather, with embarrassment and social discomfort, with genuine tragedy and sorrow, or with repressed anger. Samovar and Porter describe the following scene:
A Japanese woman servant smilingly asked her Western mistress if she might go to her husband's funeral. Later, she returned with his ashes in a vase and, actually laughing, said, "Here is my husband." Her mistress regarded her as a cynical creature, although her smile and laughter may have been reflecting pure heroism.
Charles Darwin felt that smiling was associated with aggression or self-defense. Witness how dogs, cats, and apes bare their fangs when they are threatened. Humans do the same thing on a lesser scale when they are angry or annoyed; that is we raise our upper lip, show our teeth, and flare our nostrils.
Despite mixed opinion among researchers, there is consensus that the smile under varying circumstances could indicate pleasure, humor, ridicule, doubt, acceptance, and insult. More importantly, the smile should not be taken to have diagnostic value by itself but, rather, in concert with other facial expressions operating synergistically.
According to psychologist Albert Mehrabian, the impact of ordinary conversation derives as follows: Seven percent from what we actually say, 38 percent from how we say it, and 55 percent from how we look when we say it. The implication is that the look on your face plays a much greater role in patient management than you realize. While some doctors tend to display a gloom-doom face, others radiate hope, confidence, and inspiration.
Psychologists speak of displaced hostility. Picture the doctor who shows up at his office one morning after having a nasty argument with his wife. His nurse greets him with a cheery, "Good morning," and he snaps back with a biting, "Who's my first patient?" Although the doctor may not connect his private and professional life consciously, his face, voice, and body language do reflect it.
Sick people seem more sensitive to a doctor's body language than well ones. Consider the patient with a mysterious chest pain. While having his chest auscultated, the doctor might frown or grimace unknowingly. A suggestible patient might easily assign some alarming significance to the doctor's facial expression. A similar phenomenon can occur during an adjustment. Patients receiving regular manipulation will agree that a chiropractor's approach to the laying on of hands is not always exactly the same. From treatment to treatment, it may differ in the time taken, exact point of contact, depth of thrust, or positioning on the table. Patients often notice these differences and react accordingly.
Of all the body language doctors communicate to their patients, their smiles head the list in importance. Patients equate a sincere smile with friendliness. In addition to having a salubrious effect on the doctor-patient relationship, recent studies suggest that positive mental attitudes facilitate healing by reinforcing the body's immune system. One study shows that if we assume facial expressions of happiness, we can increase blood flow to the brain and stimulate the release of neurotransmitters. Laughing, to a considerably greater extent, is said to increase the levels of endorphins in the brain which is reported to relieve pain.
Smiles vary. Parents show approval of their children by smiling; employees, perceive an administrator's smile as satisfaction. How prevalent are smiles in your office, doctor? Do you have a receptionist or nurse who never seems to smile? When you enter the treatment room of a patient who is not responding or of whom you are not particularly fond, does your face show it? All members of a chiropractic office should have their smiles rated. Do they smile? How often do they smile? Are their smiles appropriate and genuine?
Rethink your smile, doctor. Experiment with it. Consider your reaction to those patients who smile and those who do not. Is your attitude the same to both? Secretly, are you reluctant to treat the frowning or grumpy patient? Be assured, your smile is the most effective, cost-free practice builder you possess, and it is right under your nose.
Abne M. Eisenberg, D.C., Ph.D.
Croton On Hudson, New York
