The waiting room exercise

The patient waiting room can be an insightful area to learn more about how a GP practice or outpatient department work. It also allows an opportunity for members of the clinical team to gain some understanding of the waiting experience from a patient perspective (or perhaps Jerry Seinfeld’s perspective).  The waiting room exercise is sometimes recommended to medical students and trainees during their induction process: sit in the patient waiting room and just observe what happens.

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Learning objectives

1. Experience your waiting room

2. Consider the impact of the waiting room on patients

2. Kill some time by forcing you to reflect in a super boring and contagious environment

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Go and sit in your busy waiting room (during opening hours) and look at this page on your mobile phone screen if you’re allowed to.

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Questions

What happens when someone walks into the waiting room?

How do the reception staff greet someone approaching them?

Is the process confidential?

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The waiting room can be viewed as an intermediary phase between patient and clinician. Previously clear boundaries can be blurred while striking a balance between perfect conditions and pragmatic considerations. For example, confidentiality is breached when a patient enters the room and is seen by another patient who recognises them. This situation may be unavoidable. The practicalities of many waiting rooms being situated in converted residential home living rooms or Victorian era buildings preclude conditions of perfect confidentiality. However, the converse dystopian idea of sight and sound isolating cubicles hardly sounds like a warm and welcoming environment.

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Questions

Is everyone in the waiting room a patient?

Who might attend an appointment with a patient?

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The NHS website informs patients they can bring a friend or relative if they’re worried. However, waiting rooms can be a Petri dish of activity. Patients may be present with yet undiagnosed infectious disease and healthy individuals in the same environment may want to consider whether they really need to be there. The risks of communal waiting areas with a mix of healthy and poorly individuals is especially heightened during outbreaks of diseases such as influenza but there is an endemic risk too: one study found a visit to the emergency department was associated with more than a threefold increased risk of acute infection among elderly people. Cystic fibrosis outpatients clinics have measures to reduce cross infection, such as asking patients not sit in communal waiting areas but to be shown straight into a consulting room. What is perhaps even more perturbing is that a culture of healthcare concern or social etiquette in the form of accompanying relatives/friends could indeed harm patients. This is particularly pertinent during new epidemics or if a rare infection manifests where large numbers of worried (but well) individuals seek acute medical care but unwittingly expose themselves to the disease in the nosocomial environment.

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Questions

What can you see in the waiting room?

What can you hear in the waiting room?

What can you smell in the waiting room?

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A small study found ‘unloved’ waiting rooms were characterised by rolling silent TV, banal background music, leaflet clutter, out-of date magazines, and authoritative or fear inducing posters. Conversely, personal touches like local art and community news as well as light and potted plants might inspire an air of calm. Other research suggests that artwork in the waiting room might reduce stress and anxiety for patients; in secondary care it may even reduce inpatient stay and analgesic need. With regards to smell, some anecdotal accounts of a ‘sterile smell’ or the smell of other patients waiting might have an effect on behaviour.

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Questions

What do people in the waiting area do to keep themselves occupied?

Do patients take any items home? (e.g. leaflets, specimen pots?)

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Anecdotally, many people now play with their mobile phones while waiting, but this may not be appropriate in all clinical settings. There is still varying advice over whether mobile phone signals might interfere with medical equipment but the issue of camera phones and confidentiality is also important. Children might be playing with toys if there are present, but again there are questions regarding their maintenance and cleanliness.

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Questions

Did you learn anything in the waiting room?

Can you think of anything which might improve the waiting experience?

Can waiting be a positive or useful experience?

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Have you done anything to improve your waiting room? If so please consider sharing your experience in the comments section below.

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Summary

Waiting rooms are all different. They give insight into the workings of the building and the staff working in it. It is an area where confidentiality clashes with pragmatism. They can be pretty boring, although with some thought they can be modified to become more calming and even slightly interesting. They are also a hive of activity, human and microbial. Maybe waiting rooms should come with a health warning.

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Further resources