The power of the pen: how to make physicians more friendly and patients more attractive.

CONTEXT: Studies have shown that patients' subjective perceptions of physicians' competence and friendliness are relevant aspects of a successful treatment, influencing patients' well-being and trust in the physician. Psychological research has repeatedly shown that unconsciously contracting muscles that are usually used to smile can intensify and even elicit positive feelings (known as facial feedback). Empirical evidence also suggests that a smiling person is favourably judged by others with respect to attractiveness and trustworthiness. AIM: This study's purpose was to investigate how an induced muscle contraction, similar to that of a smile, affects physicians' interactions with a standardised patient. It was expected that the 'smile intervention' would affect physicians' and patients' perceptions, resulting in higher ratings of the friendliness and attractiveness of physicians in the intervention group. METHODS: Twenty physicians participated in the randomised controlled study (10 male, 10 female). Physicians were randomly assigned to one of two conditions: an intervention group (performing an easy cognitive task while smiling; n = 11) or a control group (performing an easy cognitive task without smiling; n = 9). Afterwards, physicians had a 5-minute consultation with a standardised patient. This consultation was subsequently rated by physicians, the patient and an external rater using 10-point Likert scales. RESULTS: Physicians in the intervention group were rated as significantly friendlier by the external rater (mean 7.81 versus 7.11; p = 0.097, η2  = 0.15). In addition, physicians in the intervention group rated the patient as significantly more attractive (mean 6.91 versus 4.78; p = 0.017; η2  = 0.28). CONCLUSIONS: Our results suggest that physicians can influence their friendliness and their perception of patients' attractiveness. Thereby the 'power of pen' can be an efficient method for making the hospital a friendlier place.

Improvements in teaching behavior at two German medical schools resulting from a modified Flanders interaction analysis feedback intervention process.

UNLABELLED: Abstract Background: Person-centered teachers who are more empathic and "indirect" (accept, encourage, praise and ask questions) tend to be more effective than those who are "direct" (lecture, give directions and criticize) (Amidon & Flanders 1991). The Flanders Interaction Analysis (FIA) is a tool for diagnosing these teaching aspects, though not yet used to improve lecturing in undergraduate medical education. AIMS: Does structured expert feedback to volunteer lecturers lead to improvement in person-centered teaching behavior as measured by a Modified Flanders Interaction Analysis (MFIA) and student questionnaires? METHODS: Twenty-one volunteer lecturers from two German medical faculties were stratified by past teaching experience and randomized into two groups. The intervention group received MFIA diagnoses of their lectures plus feedback by an expert observer after winter and summer semester lectures, respectively. The control group was only diagnosed with the MFIA. Teaching behavior changes for both groups were compared and teacher feedback about the intervention process was assessed. RESULTS: Faculty in the intervention group improved significantly in their summer lectures regarding person-centered teaching behavior while controls did not. CONCLUSIONS: A structured individual expert feedback intervention using a MFIA as a teaching diagnostic tool is a powerful, cost-effective faculty development process for improving teaching behavior of volunteer lecturers in undergraduate medical education.

Listen to the axillary artery: diagnosis of occult giant cell arteritis.

Large-vessel involvement is increasingly recognized in giant cell arteritis (GCA) and frequently occurs with an unspecific systemic inflammatory syndrome or fever of unknown origin. We describe the case of a 68-year-old woman with a history of polymyalgia rheumatica who presented with progressive weight loss, unexplained anemia, and a marked humoral inflammatory response. Diagnosis of large-vessel GCA was facilitated by axillary artery auscultation, revealing a bilateral axillary artery bruit. The diagnosis was confirmed by color duplex sonography and temporal artery biopsy. In elderly patients with an unspecific systemic inflammatory condition, axillary artery auscultation is a simple but valuable tool for detection of underlying occult large-vessel GCA.