By Jillian Brems, Erin Brennan, Katrina Epperson, Jordan Pearce & Anna Weber
“I just don’t want this to be the visit that changes my life,” said the middle-aged woman waiting for a mammogram at the Regional Breast Care Center. For an estimated 240,510 women diagnosed with breast cancer in 2007, their visit to the waiting room did change their lives. This is the concern that patients and their friends, families, and significant others face every time they visit the center.
This feeling of stress and anxiety isn’t just for first-time visitors either. Even women who have had many mammograms worry before a visit because, as one patient put it, “You just never know.” Women are forced to come to terms with the uncertainty factor when they enter the hospital clinic. “It’s the results I’m absolutely terrified of,” another patient said, “not the procedure.”
During this past fall the five of us—all anthropology students at the University of Notre Dame—evaluated the waiting rooms at the Regional Breast Care Center (RBCC). It has been nine years since the waiting room at RBCC last changed, and our ethnographic research focused on determining how to better meet the needs of all who use the space. The director and staff had basic questions whether the waiting rooms still fulfilled the diverse needs of their patients and those who accompany them, and what new things could be done to improve patient satisfaction and comfort.
There are three waiting rooms at the RBCC: a main room, and then a diagnostic and a screening room. When women were asked to describe their experiences in these rooms, many women began with these sorts of answers, “It was good. I don’t know what else to say,” or “Fine… I guess.”
This initial inability of patients to articulate opinions did not mean that there is no room for improvement. Instead, it suggested that the waiting rooms were already meeting the cultural expectations of the visitor. Therefore, in addition to identifying areas of improvement in the waiting rooms, it proved necessary to examine what the cultural expectations were so that RBCC could meet and exceed them.
The term waiting room in itself implies waiting. Patients expect that. Our interviews also showed that they expect a level of privacy, to experience anxiety and stress, to not be inconvenienced, and to receive the services that brought them to the waiting room.
Not one person complained about the wait time at RBCC since it fell within their cultural expectation of an acceptable wait time. The patients’ complaints were more directed toward the diversionary tools they had available to occupy their time. One woman lamented, “I hate reading out of date magazines,” and many suggested that the repertoire of magazines be improved. “Sometimes I just want to read some ‘smutty’ magazines to forget about why I’m here and all the other problems in the world.”
In addition to a wider variety of reading materials to distract from the worry, patients consistently requested a newspaper subscription and a television for use in the waiting room. These little things to divert the mind from anxiety could easily be provided by the RBCC- making it one step closer to better suiting the needs of patients while they wait.
One of the best examples we saw was when one husband left a newspaper in the waiting room. For the rest of the afternoon people picked it up upon entering the waiting room. The newspaper was current and had a wide range of topics. Since it was left by someone else, people seemed more comfortable about picking it up. It had become public property, in a sense, but there was little risk in someone walking off with a newspaper. Its shelf life was one day, and thus addressed a fear from staff than magazines, especially good ones, tend to disappear “on their own.”
The issue of privacy was also a great concern for the patients in the main waiting room. Upon entering the center, visitors were greeted by silence, as the background music played at an almost inaudible volume. As a result of the silence, it was extremely easy to hear social security numbers, employment status, and many other pieces of personal information as a patient checked in. Along with the silence, the half-circle shape of the receptionist’s window may also help project the information by acting like a megaphone for the conversations.
In addition to privacy concerns, the silence just seems to add to the feeling of vulnerability and uncertainty in the waiting rooms. Conversations rarely sprung up between visitors in the main waiting room. Even people who arrived together seemed afraid to break the silence to speak to each other. This created an environment of oppressive silence where the anxiety was palpable.
But patients expected that, too. They anticipated that they would feel stressed and anxious when they were in the waiting room. There is nothing that can be put into a waiting room that can eliminate a woman’s fear of a cancer diagnosis. The environment is not the main source of the stress; the visit is.
This doesn’t mean that the environment isn’t important. It is. One staff member — herself a breast cancer survivor who underwent treatment at the center — remembered how she felt as she waited for a diagnosis; “I felt like the walls were closing in on me when I was in the main waiting. There was no natural light, nowhere to look.” Of the three rooms, only the screening waiting room has a window that allows for natural light, which most women cited a preference for.
One patient said that she would like the waiting rooms to be more cheerful because everyone “already has enough worry and darkness in their lives to be surrounded by darkness while they are waiting.” This woman was referring to the color of the walls and seating areas, which are deep purple, brown, green, and tan. She also felt the “dull art work on the walls, if you can even call it art work,” contributed to this ominous presence of the waiting room.
Patients also didn’t want to be inconvenienced during their journey through the waiting room. The small welcome sign directing patients were to check-in was not visible to the visitors who enter the center, leaving many turning in circles upon entering and thus compounding the inherent stress of the visit. The door at the entrance poses another problem. “You can’t see out the door,” one staff member explained who has almost accidentally hit patients as they entered the center, “There are no windows so it’s always a guessing game as to whether or not there is someone on the other side.”
The final cultural expectation that patients had when entering a waiting room was to receive the services that brought them to the center in the first place – which they do. But RBCC has gone one step further and routinely exceeds the expectations of the visitors.
All of the patients raved about the care they received at RBCC. “The quality and care is unmatched,” noted one breast cancer survivor. “They try so hard to make you feel as comfortable as possible and are so easy to contact with any questions that you may have.” “They are the ones,” another woman said, “that can make my visit a little less stressful and a lot more enjoyable.”
Unfortunately, as mentioned earlier, there is nothing that can be done to the waiting room to completely remove the concern of a cancer diagnosis. However, one woman summed up the power and potential of waiting rooms nicely. She explained that the best way to improve the waiting room is “with the small things, the things that set off the big reactions.” For example, senses can be heightened while stressed such that aspects of each of the waiting rooms including color, seating arrangement, and accessibility can become even more noticeable to the already worried patients. Therefore, we came to see the role of RBCC to be to make the environment as stress free as possible by choosing gender neutral, soothing colors and artwork, posting clear signs, and eliminating any obstacles to accessibility.
So the little things it is. Framing the waiting room at RBCC within the cultural expectations of the visitors made it possible to find out what those ‘little things’ were in order to better understand the experience of patients in the waiting room and how to best suit their needs. RBCC has done an exceptional job in exceeding the cultural expectations of wait time and patient care and should continue to do so.
But the center can still improve. It should provide more diversionary tools for the patients such as newspapers, a television, and a wider variety and more up to date magazines. The signs and accessibility can be improved, and while there were no major problems with the physical aspects of the waiting room, it is important to keep the patients best interests in mind when choosing things such as color, lighting, and seating.
As the nurse who had survived breast cancer said, “Cancer doesn’t hurt as much physically. It hurts here and here,” pointing first to her head and then to her heart. While the waiting room cannot erase that ‘hurt,’ it has the potential to alleviate some of it through small changes. No patient’s visit to the waiting room should be magnified by unnecessary stressors of their environment. The potential of a negative diagnosis is what induces these stressors, and is also what makes the space more than a waiting room; it makes it a place that could change a women’s life.