By Brian Chou, OD, 
FAAO
The Pygmalion effect is the phenomenon in which the greater the expectation placed upon people, the better they perform.
The golem effect is a psychological phenomenon in which lower expectations placed upon individuals either by supervisors or the individual themselves lead to poorer performance by the individual. It is a form of self-fulfilling prophecy.
–Wikipedia
A restaurant that I like has intimidating signs at its front door. One prohibits smoking, one says “Warning” and outlines dangers related to alcohol consumption, while another describes potential illness from consuming seafood. While these may be mandatory disclosures for regulatory compliance, consider the hostile effect these signs have on a patron’s mind.
I see similar negative messaging when I pass by some healthcare practices. Conspicuously displayed are non-required signs about policies, signs that scream: “You cannot do that!”
How does this happen? They often are a knee-jerk solution to serving ourselves, forged without regard for the majority of our clientele.
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• If a patient answers their cell phone during an exam, some owners might post a sign that says, “Turn off your cell phone.”
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• If a patient tries not to pay their balance, some might post a sign that says, “Payment due at the time of service.”
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• If a patient arrives 20 minutes late and expects to be seen when the next patient has already arrived, some might post a sign that says, “If you are more than 15 minutes late, you may be asked to reschedule.”
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• If a patient no-shows, some might put up a sign that warns of a no-show fee.
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The examples can go on, with a tendency of creating a rule to counter the rudeness.
For some OD-owners, the intent is to teach the common-sense manners that are dwindling among the younger generation. For others, it’s about making their workday proceed more smoothly. In so doing, however, an intimidating and unwelcoming environment is created.
Why are we creating an environment that is intimidating and unwelcoming?
Further, such negative signs have a tendency to proliferate. To the new patient, a hodgepodge of signs communicates that you are beginning the patient-doctor relationship with an air of mistrust.
Why should respectful and pleasant patients feel uncomfortable and penalized because of a small handful of inconsiderate patients?
The better approach is to be selective. Have your staff verbalize your policies on a case-by-case basis, or have them written down somewhere out of normal view, where patients can be shown them as necessary. There is no need to broadcast the rules when they only apply to a small number of patients.
Ultimately, you cannot regulate rudeness or stupidity; boorish behaviors are an unavoidable part of doing business. Harness the Pygmalion effect in your business: If you presume that your patients will act in a courteous manner and communicate that confidence and expectation, it tends to become a self-fulfilling prophecy.
The exact opposite, the golem effect, is exemplified by displaying signage that shows mistrust and the creation of barriers. Patients will pick up on that negative scent and act defensively. I’m not saying to abandon all non-mandatory policies. They are often necessary and helpful, but display them tactfully in a targeted manner.
Have you posted intimidating policy signs in your office that your staff must enforce? Should policies be based on the bad behavior of a small pool of patients?
Brian Chou, OD, FAAO, is a partner with EyeLux Optometry in San Diego, Calif. To contact him: chou@refractivesource.com.
