Working the Waiting Room: Managing Fear, Hope, and Rage at the Clinic Gate

Abstract

In this article, we outline the contrasting perspectives of patients and receptionists and the different ways they experience waiting rooms in three U.S. medical clinics. We are doing this to show that a consideration of waiting rooms and the receptionists who work there is an important step in understanding the patient care-seeking experience. We describe the kinds of conflicts that emerge around patient waiting and the emotional labor that receptionists perform to reduce these conflicts by managing patient feelings. By doing this we expand the frame of the clinic visit to include the emotionally important space of the waiting room and revisit the concept of “emotional labor” as a way to understand non-medical care giving in clinic settings and the cultivation of emotions in others. In doing so we show the important role that clinic receptionists may play in shaping how and when patients receive health care.

Key Words:

• clinic work
• emotional labor
• health care
• patient care
• receptionists

ACKNOWLEDGEMENTS

This material is based on work supported by the National Science Foundation under Grant No. 0137921. In addition to M. Cameron Hay and Cynthia Miki Strathmann, the research team included R. Jean Cadigan, Terri Anderson, Jill Mitchell, and Lan Nguyen. The research was conducted out of the Center for Culture and Health, at the UCLA Semel Institute for Neuroscience and Human Behavior. Our thanks to Kevin Groark, J. Timothy Sundeen and Melissa Park for their helpful comments. Our thanks also to the physicians, patients and especially the receptionists for their time and insightful remarks.

Notes

The particular focus of Hay's larger study was how patient access to information, particularly over the Internet, influenced clinical interactions, and patient illness experience.

We could have gathered more information if we had questioned patients directly about receptionists or waiting rooms. We did not do so because initially waiting rooms and receptionists had not been our focus, but emerged as an important topic during our study. This limits the number of patients we heard from, but has the advantage of only including input from patients that they themselves felt important. One result of this methodology is that we are focusing on situations that patients found remarkable (usually not for good reasons) rather than situations that they found mundane. Consequently, our picture of patient perspectives is limited to particularly noteworthy occurrences or problems (documented through our observations or patient's unsolicited comments).

Our patient sample was 5 percent African American, 7.6 percent Latino/a, 6 percent Asian, 8.7 percent Middle Eastern or East Indian, and 72 percent White or didn't state their ethnicity. Income was fairly evenly spread out: 14.5 percent of patients had household incomes less than $20,000, 14.5 percent between $20,000 and $40,000, 13.9 percent between $40,000 and $60,000, 16 percent between $60,000 and 80,000, 12 percent between $80,000 and 100,000, 11 percent between $100,000 and $120,000 and 13 percent $150,000 or more.

This and all other personal names in the article are pseudonyms.

The one exception to this was one of the receptionists in Clinic Three, who had worked for years for a senior physician in the clinic prior to that physician's relocation to Clinic Three. The length of time that they worked together seemed to give her immunity to complain to this physician to implement policy changes.

While the jobs did have significant turnover due to the workload, there was a great deal of individual variation between workers and between clinics. Turnover was very low in Clinic Three but fairly high in Clinics One and Two (Clinic Three was much less busy). Although higher, turnover in Clinics One and Two was variable. Of the four receptionist positions in Clinic Two, for example, three saw no turnover while we were doing the study while the fourth saw at least three different occupants. The remaining three receptionists commented that they had been there an unusually long time and that turnover was often high because the job was busy and could be stressful.

We counted new interpersonal interactions (not a new speaking turn, but an interaction with someone who had not been interacting with the receptionists directly before) for receptionists during eight observations lasting between 20 and 60 minutes and occurring at all times of day.

Note that the initiation of a new interaction may and regularly did occur while the receptionist was still fielding a previously initiated interaction. For methodological reasons, we did not measure interactional duration.

Our thanks to J. Timothy Sundeen for this observation.

Additional information

Notes on contributors

Cynthia Miki Strathmann

CYNTHIA MIKI STRATHMANN is a social anthropologist interested in work and emotion and in how people use cultural resources in struggles over power and authority.

M. Cameron Hay

M. CAMERON HAY is a medical and psychological anthropologist and is a member of the editorial board of Medical Anthropology. She is interested in the social distribution of medical knowledge in health care and the ways people experience and cope with illness, particularly chronic illness.