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Views And Reviews Critical Thinking

Matt Morgan: How watching Friends may prevent your next complaint

BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2531 (Published 19 October 2021) Cite this as: BMJ 2021;375:n2531
  1. Matt Morgan, consultant in intensive care medicine
  1. University Hospital of Wales
  1. mmorgan{at}bmj.com
    Follow Matt on Twitter @dr_mattmorgan

The opening bar of the theme tune for the TV programme Friends takes me straight back to my teenage years, nearly three decades ago. Yet, like many medical treatments, old fashioned trends often come back around. My daughter’s favourite t-shirt in 2021 proudly displays the famous logo on the front, as mine did back in 1995. Watching the series for a second time, I was struck by how much has changed in life, and how much has stayed the same. Again, a bit like medicine over the past 30 years.

The Canadian author Malcolm Gladwell has a particular fascination with the show, claiming that he could watch an entire episode on mute, yet still perfectly understand the plot. This is thanks to the often exaggerated facial expressions of the actors, perfectly matching the words coming from their mouths. When analysed using the Facial Action Coding System, Friends shows extreme concordance between facial display and the sentiment of the script.

We have long known that not only what is said, but how it is said matters to patients and colleagues. I would go even further by saying that the most important part of a conversation is how you leave people feeling. If your face displays something different from your words, especially when breaking bad news, it can leave patients confused, upset, or doubtful of your sincerity, weakening the doctor-patient relationship and potentially contributing to complaints. Clearly, masks that cover the movement of our 43 facial muscles may weaken the links between expression, communication, and trust even further. I have certainly been using my hands, eyes, and forehead much more since the pandemic started and my mouth can now only be used for words.

Critically, the ways in which certain facial expressions or gestures match particular words depends on several factors, including cultural background. A head shake doesn’t always mean no, a nod doesn’t always mean yes. Sometimes, the opposite is true. This might cause mild confusion outside of a healthcare setting, but when families are hanging on every word and gesture, this discordance could make the difference between a complaint and a compliment.

Short of replicating the hair flick of Jennifer Anniston or broad white smile of Matt Le Blanc, how can Friends practically help healthcare professionals? Perhaps we should review recorded consultations with the sound off. If you can’t tell whether good or bad news is being given, working on your body language rather than words might be useful. In cases of difficult communication or language barriers, exaggerating facial expressions to reinforce the message may help. This is especially true if you’re wearing a mask, where your forehead and eyes need to take up the work of your mouth. Finally, better training on how culture affects the meaning of common gestures could avoid contradictory signals. Dealing with loss is hard enough for families, especially when they feel that “no one told them life was gonna be this way.”

Footnotes

  • Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no competing interests.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • Matt Morgan is an honorary senior research fellow at Cardiff University, consultant in intensive care medicine, research and development lead in critical care at University Hospital of Wales, and an editor of BMJ OnExamination

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