by Emily Harrison
The medical receptionist traverses the interface between physician and patient, bureaucratic and clinical work, and emotional and administrative roles. The complexity of their position in the workforce is something largely ignored by academic literature, but which my experience of working in a surgery over the summer enabled me to appreciate first-hand.
In the first instance, Neuwelt et al (2014) consider the medical receptionist to be a ‘gatekeeper’: the “public face of the physician” (p. 288), whose discretionary role can determine access, or lack thereof, to medical aid. As gatekeeper, the receptionist can deny patients appointments if not deemed clinically necessary, especially in the case of walk-in appointments, which are reserved for medical emergencies. As a result, the receptionist shoulders the burden of medical responsibility in spite of not being medically trained. In my experience, this was a particular challenge when communicating with patients over the phone, where necessary information can be deceptively or only partially conveyed, as explored by Cicourel in 1999. Patients will often assume their right to access medical attention, and the receptionist’s power to deny this can frame them negatively as ‘judgemental’ or ‘cold’ (Neuwelt et al, 2016). When such access is denied, hostilities often materialise in the form of abuse directed towards the receptionist (Eisher and Britten, 1999).
Patient hostility is something which I both witnessed and experienced throughout my time at the surgery. Receptionists will often refer to abusive patients as “difficult”, however, importantly, their role necessitates that they distinguish between those who act out of unjustified anger, and those who act out of genuine vulnerability. The receptionist is in contact with some of the most mentally and physically ill members of our society, and as such has to learn to engage with compassion even in the face of abuse. They must learn to limit their judgement and convey care in a completely neutral way, despite being the “first point of attack” (Neuwelt et al, 2016. p. 127) for disgruntled or unruly patients. This is an especially difficult task to undertake where patients have issues with drug and alcohol addiction. Heuston et al (2009) found that such patients were seen to demand attention and treatment beyond reasonable boundaries, and that receptionists often experienced heightened hostility from these patients. Difficulties arise when the patient does not correspond with the pre-determined rules and conventions which enable a system to run smoothly. For example, addicts were more likely to insist on being seen, even when appointments were not available or necessary. These patients would also breach social codes and conventions in the waiting room (the space over which a receptionist can exert authority) by reacting in an aggressive manner, or exhibiting behaviour which disrupts the experience of others (eg the consumption of alcohol around children). The waiting room embodies a figurative and literal space of division between patient and physician, over which the receptionist has power. As such, tensions between clinical structure and patient need are projected onto the space when “difficult patients” act outside of social and professional conventions (Strathmann and Hay, 2009). It falls to the receptionist to determine the patient’s real level of need, and to balance their duties of care and practice.
The importance of medical receptionists engaging empathetically with patients is therefore clear, but their role also demands of them the ability to manage emotions (both of themselves and patients). Hoschild (1979) coins this responsibility a form of “emotional labor”. Strathmann and Hay (2009) argue that receptionists have to manage their emotions (eg by limiting frustration, and acting empathetically even in challenging or frightening conditions) in order to diffuse situations and, importantly, counteract the negative preconception held by the patient that the receptionist represents an obstacle between themselves and the physician. Emotional labor is not often recognised as a duty of the receptionist; not being an official task or responsibility. It is, however, a crucial aspect of their job and of the patient-care process in general, which Williams (2003) contests is underappreciated by both clinical staff and the medical system in general. Receptionists are offered no training or support in dealing with a ‘demanding public’ (Williams, 2003) (a people who expect more emotional labor than they should, such as patients), and as such, are expected to use their own initiative to develop interpersonal skills on the job.
An important consideration here is the role of gender divisions within the workplace. I worked in an all-female team of 8 receptionists- a gender bias mirrored across most practices. Neweult et al (2014) note that “the waiting room is…a gendered space…most GPRs being women and part time, poorly paid workers” (p294). Women are perceived to be more suited to the demands of the job because of their supposedly greater emotional capacity, and even their ability to multitask under pressure- a requirement of the job which Neuwelt et al (2016) found to be routinely undervalued by other members of staff. As a result, receptionists often feel disempowered in their role. More broadly, their limited agency in the system they operate within means that they are criticised for situations over which they have no control (such as waiting time), and must learn to engage in emotional labor in order to manage such interactions. The receptionists become the “personal representations of bureaucratic power, although they do not have much of their own” (Strathmann and Hay, 2009. p. 214).
To conclude, the role of the medical receptionist is complex and undervalued, both in the workplace and by academic interest. A progressive insight into the consideration of the role of the modern-day medical receptionist must recognise that “patient health care begins in the waiting room through interactions with those who are not trained as health care providers at all” (Strathmann and Hay, 2009. p. 230).
Cicourel, A. (1999) The Interaction of Cognitive and Cultural Models in Healthcare Delivery. In Talk, Work, and Institutional Order. Srikant Sarangi and Celia Roberts, eds. Pp. 183–224. Germany: Mouton de Gruyter.
Eisner, M. and N. Britten (1999) What Do General Practice Receptionists Think and Feel about Their Work? British Journal of General Practice 49(439):103–106.
Heuston, J., Groves, P., Nawad, J., Albery, I., Gossop, M. and Strang, J. (2001). Caught in the middle: receptionists and their dealings with substance misusing patients. Journal of Substance Use, 6(3), pp.151-157.
Hochschild, A. R. (1979) Emotion Work, Feeling Rules, and Social Structure. The American Journal of Sociology 8(3):551–575.
Neuwelt, P., Kearns, R. and Browne, A. (2015). The place of receptionists in access to primary care: Challenges in the space between community and consultation. Social Science & Medicine, 133, pp.287-295.
Neuwelt, P., Kearns, R. and Cairns, I. (2016). The care work of general practice receptionists. Journal of Primary Health Care, 8(2), p.122.
Strathmann, C & Hay, M (2009) Working the Waiting Room: Managing Fear, Hope, and Rage at the Clinic Gate, MEDICAL ANTHROPOLOGY, 28:3, 212-234, DOI: 10.1080/01459740903070840
Williams, C. (2003) Sky Service: The Demands of Emotional Labour in the Airline Industry. Gender, Work, and Organization 10(5):513–550.