How doctors decorate their consulting rooms can be a matter of style, personal preference, territorial imperatives, or culture. Some doctors believe that patients need to see certain images and motifs there. Take the average heterosexual middle aged clinician. He or she will have pictures of his or her family prominent on the desk, with kiddy drawings scattered around the walls. Doctors approaching retirement may have additional photos of grandchildren.
Doctors should abstain from having family photos in their consulting rooms
There is a widespread feeling in the medical profession that patients are reassured by seeing their doctor in a family role—one, it could be said, with which they can identify and which generates trust. Many doctors would recognise that having a family has immeasurably improved their consulting style; but is the consulting room truly the place to put the family on display? I really do not think so.
After reflecting on the vulnerability of my patients, I have removed my family photos from my consulting room. Many of my patients' lives have been utterly blighted by long term mental illness and they will never experience the exquisite joy of having children. Often they are poor, working class, isolated, and from a traumatically dysfunctional background; whereas I am a white, middle class, professional, affluent psychiatrist. Surely it is not right to confront them with images of a happy family life, thus accentuating the colossal gaps that exist between us?
It is not merely those with mental health issues who may be painfully touched by happy family images. What about the 10% of couples who are infertile and who often, as a result, experience chronic sorrow? Or those who may have had a miscarriage or have a child with special needs, or, indeed, are attending to seek a termination? What about women who have been physically, emotionally, or sexually abused or young people finding their way in life—are they likely to warm to, trust, or listen to a person flaunting such alienating images and who displays about as much congruence with them as a Martian? How do gay patients feel about such rampant displays of heterosexuality? How do refugee patients who have lost everything feel about such images of ebullient and affluent normality? So many of our patients are beyond the social pale and suffer profoundly for it. The classic consulting room photos must accentuate these feelings.
We doctors have it all—a marvellous vocation and an affluent lifestyle that enables us to give any children we have a head start in life. Is it tenable for us to present patients with such an emotional challenge during a consultation, when they are likely to be feeling emotional anyway? I suggest that they may leave the consulting room more upset than when they entered it, because when someone is vulnerable already, other painful issues tend to come flooding into one's consciousness.
Maybe in reality it is the doctors who need fortifying with supportive family images—for example, to dilute the impact of the heart sink patient or even to keep the patient at a physical distance. It is strangely ironic that doctors who loudly declare that they do not divulge personal details of their lives to patients nevertheless confront them with immensely revealing, evocative images of their families.
Patients do notice family photos in the consulting room, as do their friends and families, if and when they accompany them. I have received many comments about photos, even those hung discreetly. We doctors often forget that patients are as interested in us as we should be in them. A portion of the average patient's attention is focused on assimilating details about their medical practitioner, with motives no more prurient than our own. Practice or hospital leaflets giving details of our qualifications and medical school do not in any real sense empower patients. Patients therefore, quite appropriately, seek other clues to our identity.
I believe strongly that doctors should abstain from having family photos in their consulting rooms. To have them on display is to forget utterly what the purpose of the consultation is—that is, to be patient centred.
It is quite possible to make a consulting room friendly and welcoming without the specifically personal dimension of photos. Colour schemes can be altered to include more pastel shades rather then clinical white. Why have drug company posters with frightening names and bland images when one can frame a poster for a few pounds? Lighting does not have to blaze down from fluorescent tubes when there are modern systems that shine softly at the ceiling, providing a more therapeutic environment for patients to reveal their physical and mental distress. Rugs and carpets can be employed to inject warmth. Interior designers can be consulted.
The ways in which we doctors choose to imprint our personalities on our consulting rooms are many and varied. There must be plenty of scope for a thesis on what is an important aspect of the doctor-patient relationship.