Notices: just say no!

Mike Fitzpatrick

If, as William Osler wrote, a human being can be defined as a ‘medicine-taking animal’, then surely a health service professional can be defined as ‘somebody who likes putting up notices’. The profusion of waiting room notices in surgeries and outpatient clinics is commonly justified by the conviction that these provide useful information to our patients. In fact, such notices are at best condescending, and at worst, express a worrying degree of fear and loathing of patients.

In my surgery we recently succumbed to staff pressure to put up notices banning the use of mobile phones (my suggestion that we should use posters publicising the well-known facts that they cause male infertility and brain tumours was vetoed). It soon became clear that the notices were completely ineffective. People ill-mannered enough to talk loudly into their mobiles in the waiting room — even in the consulting room — continued to do so. The only effect of the notices was to cause mild irritation to the vast majority of patients who have always politely switched off their phones.

The mobile phone notice experiment confirmed my prejudice about that most familiar of waiting room posters — the one proclaiming ‘zero tolerance’ of violent or abusive conduct. Although these posters inevitably have zero effect on anybody inclined towards aggression, they are offensive towards the other 99.9% of our patients who would never resort to such conduct. The popularity of ‘zero tolerance’ notices with health service bureaucrats reflects bad faith. On the one hand they affect a concern for staff welfare and on the other a concern for consumer satisfaction. But posters threatening legal action against offenders provide illusory protection for staff while expressing a contemptuous attitude towards patients. Of course, it is easier to put up pompous notices than to reduce delays and provide proper training for receptionists.

Every week a pile of posters and leaflets arrives for another campaign to raise awareness of some obscure syndrome or to promote some worthy cause or virtuous health-enhancing behaviour. In my surgery, these go straight in the bin, a grievous waste of resources and contribution to climate change. The common presumption of all this propaganda is that patients in the waiting room are a ‘captive audience’ susceptible to being hectored, patronised or merely educated into enlightened behaviours and healthy choices. But people waiting to see a doctor or a nurse are often ill, sometimes distressed, always entitled to sit and wait without being the objects of instruction and manipulation.

Many years ago, when I worked briefly as a locum I began the day in a surgery deep in the inner city and ended it in suburbia. At the morning surgery in a left-wing health centre, the waiting room was adorned with posters exhorting patients to join protests against the cuts and demonstrations in solidarity with the people of some Third World country, as well as notices about the evils of cigarettes and alcohol. In the evening clinic, patients waited in comfortable wicker chairs faced with a tank of tropical fish and a few tasteful reproductions of old masters — without a notice of any sort in sight. Although I had some political sympathy with the morning doctors, I couldn't see why their patients were not entitled to the sort of restful and respectful environment enjoyed by middle-class patients.

I wonder if this difference still exists. Radical doctors who once sought to mobilise their proletarian patients are now more inclined to regard them as perpetrators of racism or domestic violence and now use posters either to educate them or to threaten them with retribution. Conservative doctors seem equally inclined to regard their patients as potential aggressors — or litigators. The proliferation of notices in all surgeries reflects the deterioration of relations between doctors and patients.

My modest proposal: abandon the waiting room notice board. In my surgery, we have long refused to display ‘zero tolerance’ posters (and incidents of aggressive behaviour are as rare as they have ever been). I have tried—with some success — to persuade my colleagues to replace all the remaining notices with art works — or with blue-tack resistant paintwork. I am confident that this will improve the environment aesthetically, and it may also help to improve relations between patients and practice staff.