How to be an Authentic Doctor #4: Smile


How is that I have to point out the need for one of the most basic human expressions known to man?  I will tell you how.  Look around.  How many doctors do you know that even smile anymore?  It’s almost rare to find one.  I imagine holding a picture similar to the famous bigfoot photograph but this time it is a doctor with a smile on her face.  And everyone would doubt its authenticity.  “That’s a photoshop job!” they would say.

It’s funny because we are taught in medical school that kids are not really sick if they are smiling.  It’s not 100% accurate but it’s pretty close.  What does this say about doctors?  The scowls I have seen over the years and continue to see are just too commonplace.  This is a problem.  The rare doctor I see smiling or looking happy is the one who is soon to be retiring.  I remember one doctor being so happy who had NOT smiled in years.  I asked him why and he told me that he was diagnosed with prostate cancer.  He wasn’t going to die but he was going to quit practicing medicine.  Crazy, right?  This says more about our profession than any other statistic or study I could find.   It also tells me that a lot of doctors are sick.

Most patients who come to you are either ill or have things wrong with them.   They are in need of a smiling face.  They feel your lack of smile as a lack of happiness.  And it spreads back to them.  Not that you have to smile the whole time but a perpetual frown or face of indifference has far reaching implications.  How many of your receptionists smile?  How about your medical assistants or nurses?  Look around one day as an experiment and let it scare the hell out you.  It’s not all their fault.   They used to smile too but the system beat it out of them just like it beat it out of us.

My advice to you is to find your smile again.  If you can’t find it then force it for a while.   Here is what Dale Carnegie said about smiling:

Your smile is a messenger of your good will. Your smile brightens the lives of all who see it. To someone who has seen a dozen people frown, scowl or turn their faces away, your smile is like the sun breaking through the clouds.

Actions speak louder than words, and a smile says, “I like you, You make me happy. I am glad to see you.” That is why dogs make such a hit. They are so glad to see us that they almost jump out of their skins. So, naturally, we are glad to see them.

Could you as a doctor do this?  Sure you could but it would take work and you are too busy trying to check meaningless boxes in your EMR or dealing with the 8th problem on someone’s list of complaints or waiting for a healthy young diabetic to take off his shows even though they obviously having nothing wrong with their feet.   So you frown your day away and get your “stuff” done but you go home with the same scowl and ponder whether this job is worth it.

Here is the bottom line.  Smiling will actually make you feel better.  I am not trying to be a touchy, feely guru trying to make you find that inner child but I will tell you this, for some reason, it works.  And it gets others to smile, too.  So, the next time you go to work please force yourself to smile at least once or maybe a few throughout the day.   Do it by thinking of the good things going on in your life.  Or think of something funny that happened in college like the time you drew all over your passed out friend’s face.   Or think of a funny joke, a funny movie, a little kid laughing.  Or think about retiring WITHOUT a diagnosis of cancer.   It doesn’t matter.  Just do it.  Your patients will appreciate it.  Your staff will appreciate it.  And you will appreciate it.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “How to be an Authentic Doctor #4: Smile

  1. tad hominem
    March 19, 2014 at 8:29 pm

    so true, and so sad. great advice, Doug. it can’t hurt to smile, either at the start or at the end of the visit.

  2. March 19, 2014 at 4:33 pm

    Even better get the patient to LAUGH, either at themselves or at YOU!! Yes, we can be laughed at!! It removes that veil of inability to do what we thought we’d be doing!!

  3. Randy Gould
    March 19, 2014 at 1:36 pm

    Thanks for all the great advice, as well as amazing humor over the years. There is an old quote from someone that I learned early in med school which goes, “remember to smile, for nearly everyone you meet carries a heavy burden.” For 37 years I tried very hard top remember this advice, and, in addition, to always try and provide a compliment, or discuss something about a patient’s life other than their medical problems. Like you I also never used a computer while seeing a patient, with the only exception being reviewing a digital Xray. It is really hard for me to see what is happening with our profession, and, like you, I feel the only way things can get better again, is if we all just refuse to accept all these dehumanizing rules and trends. I was able to retire this year, and can’t conceive of even working part time anymore, even though I’m still really good at what I do. Anyway thanks again for your voice!!
    Randy G.

    • Doug Farrago
      March 19, 2014 at 2:42 pm

      You’re welcome and thank you for the work you do!

  4. Mary K
    March 19, 2014 at 8:08 am

    As a former RN I guess I never really thought about this until my husband came home from a dr. visit and said he thought there was something wrong with his doctor because he didn’t smile during the whole visit. We forget that people make assumptions based on our demeanor and we need to present our best face to them.

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