by Carolyn Thomas ❤️ Heart Sisters (on Blue Sky)
I wrote last week about the overwhelming experience I’d just had in the Breast Imaging Clinic at our local hospital. I was there for a mammogram because I’d recently found a lump in my right breast. Something suspicious was spotted on that mammogram, so an ultrasound was immediately next in line. Then something even more suspicious was spotted on the ultrasound, which prompted the radiologist who reviewed my tests to announce that I needed a biopsy to rule out breast cancer. (FYI: I’ll likely learn my pathology results on Tuesday). UPDATE: The “not wonderful” new diagnosis I didn’t see coming
But what I didn’t mention last week was something I’ve been thinking about since that day – which was my shocked reaction to spending time in the Breast Imaging Clinic waiting room – but not for the reasons you might expect:
Let me say up front that, like most patients living with heart disease, I’ve spent countless hours sitting in medical waiting rooms over the 17 years since surviving my misdiagnosed “widow maker” heart attack – so I feel reasonably qualified to offer my personal opinion of medical waiting rooms, namely:
“I’ve never once sat in a cardiologist’s waiting room filled with patients who are smiling and chatting with one other. I’ve never once experienced any medical waiting room where the other people waiting alongside me not only called out “Hello!” to arriving patients, but also “Bye! Good Luck!” to those leaving the room.”
But that’s precisely what I observed during about five hours in and out of our local Breast Imaging Clinic that day: one after another, women in our waiting room smiling and chatting – and even laughing. By the time I finally left for home, I too was waving goodbye to the group.
What the heck is going on in Breast Imaging Clinic waiting rooms?
Are all of them as friendly as this? Is this level of socializing unique to breast cancer circles? And how can we learn their secret so we can reduce the isolation and dread that’s so often part of our waiting room experiences in cardiology?
While I was being prepped for those four Core Needle biopsies in my right breast last week, I asked the Breast Imaging Clinic staff about what I’d just witnessed in their waiting room. The ultrasound tech assured me it was not an unusual occurrence. She’s worked in this Clinic for years, and has “seen amazing conversations evolving between the women waiting in that room,” adding, “Sometimes you’d swear it sounds more like a group of old friends chatting together – instead of strangers!”
In my own personal experience, a cardiology waiting room, by comparison, is essentially a place of silence.
People waiting there are typically sitting, eyes down, staring at a newspaper or phone, looking very serious. They look neither left nor right, except maybe to briefly check the time, or glance at the receptionist whenever she calls out the next patient’s name on that day’s schedule.
The only reason we are sitting in a cardiologist’s waiting room is that something is wrong with our hearts, or something might be wrong with our hearts. That’s pretty serious stuff.
But isn’t the possibility of a breast cancer diagnosis just as serious?
There are few if any studies on how patients behave in waiting rooms. One related reference I found was called “Neuroanthropology” in which the University of Notre Dame anthropology department(where students research “elements of the human condition”) was asked by the director of their Regional Breast Cancer Care Center (RBCC) to assess “patient satisfaction and comfort related to their waiting room visit.” *
The survey results may seem familiar if you have spent any time in any medical waiting room, as their report suggested:
“The term waiting room in itself implies waiting. Patients expect that. Our interviews also showed that patients expect:
- to experience anxiety and stress
- to not be inconvenienced
- a level of privacy
- to receive the services that brought them to the waiting room
That sounds like what cardiac patients would also expect, doesn’t it?
The report then continued:
“Not one person complained about the wait times at RBCC – since those times fell within patients’ cultural expectation of an acceptable wait time.”
The patients’ concerns included a range of comments:
- “I hate reading out-of-date waiting room magazines.”
- “I prefer newspapers or television in the waiting room to divert the mind from anxiety.”
- Visitors entering this room are greeted with silence.”
- The background music is almost inaudible, which makes it easy for other people in the waiting room to overhear the receptionist repeating my personal information.”
And quite unlike my own surprising experience of socializing in my local Breast Imaging Clinic waiting room last week, this report said:
“Conversations rarely sprung up between patients in the main RBCC 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.
“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. 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, as one patient suggested:
“It’s the results I’m absolutely terrified of – NOT the test.”
The report continued:
“Patients expected 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.”
I agree with almost all of that – except that, although I did feel apprehensive before that day’s appointment, at least three of the women in that room smiled up at me and said “Hello!” when I walked in. So of course, I said “Hello!” back to them, and joined in some of the conversations. (And then later, I was also one of the women waving goodbye, too!)
It struck me that somebody – even just one person – must have started that welcome practice, perhaps the first appointments of that day, or was this – as the clinic staffer told me – a frequent feature of this particular waiting room?
But I was also greeted at that time by those three welcoming voices in the waiting room. Was this behaviour modeled on what patients had learned from women ahead of them? Is this why patient support groups can be so helpful – simply by reminding us that we are not alone, even in the scariest moments when our future is still unknowable?
This reminded me of a similar behaviour shift during the years I commuted to work by bus. At every stop, the bus passengers getting off via the rear door would call out to the bus driver up front: “THANK YOU!” as they left the bus -because everybody else was doing that, too. (My American friends viewed this charming practice as a hilarious example of Canadians being overly polite!)
The longer I sat in that Breast Imaging Clinic last week, the more women I watched arriving before their tests or leaving. afterwards. It seemed that nobody arrived or left without a greeting and a wave goodbye.
This was a remarkable experience to witness – and a profoundly impactful difference compared to my cardiology waiting room experiences.
And as one of the middle-aged women interviewed for Neuroanthropology summed up:
“I just don’t want this to be the visit that changes my life.”
See also: Waiting, Worrying & Medical Test Results.
♥
* (Neuroanthropology is a broad term, described as “intending to embrace all dimensions of human neural activity, including emotion, perception, cognitive, motor control, skill acquisition and a range of other issues.)
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UPDATE: How’s this for kindness in health care?
My Nurse-Practitioner – who was on vacation at the time – sent me this note the day after my biopsy:
“Hi Carolyn – I do not have your pathology results back yet. I was just wanting to check in and see how you were doing, as the procedure was more extensive than just an ultrasound. I will keep an eye open for the results and give you a call when I see them…”
♥
Q: How friendly and chatty are the patients in your medical waiting room?
NOTE FROM CAROLYN: I wrote more about coming to grips with a frightening diagnosis (cardiac or otherwise) in my book, “A Woman’s Guide to Living with Heart Disease” (Johns Hopkins University Press). You can ask for it at your local library or bookshop (please support your favourite independent neighbourhood booksellers, or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 30% off the list price).
See more on how this all started:
Heart Sisters 
I was trying to see if you had posted since your biopsy results but I did not see anything- hoping you had good news and/or that you can see a path through whatever was or wasn’t found. As soon as I read the article I wanted to respond, but forced myself to not always be the “first responder”!!
I had a very similar experience to you when I was in the diagnostic mammogram waiting room on New Year’s Eve afternoon. There were quite a few of us and I knew, sitting there, that not all of us would get good news. But all the people were so friendly and kind and encouraging. The clinic provided some snacks and drinks – like water, juice, and soda. But the best part was the other patients who were so kind and encouraging. And I, fortunately, got good news that day and was so relieved that as I stood in front of the elevator- I thought I was alone– and just kind of leaned over– kind of my head to my knees in relief- and another patient saw me and immediately rushed over to make sure I was OK.
Yes, we need way more of that kind of kindness and compassion in many areas of our society.
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Hi Helen – what a touching story of that other patient rushing over to comfort you!
I haven’t yet posted here the pathology results of the biopsies I mentioned in this post – still waiting for one more consult when I’ll know more – and I’ll post the news then. Thanks so much for your kind words.
❤️
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Hello Carolyn,
I experienced the same thing some years ago in the waiting room at West Coast General Hospital while waiting for an ultrasound after something suspicious was found during a routine mammogram. The other women waiting with me were all chatty and those who had already had ultrasounds or biopsies were empathetic to those of us “first-timers”. I found it very empowering and encouraging. Wish all waiting rooms were the same!
Hope your results were good.
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Hello Sue – I too felt as you did in that waiting room – very encouraged – and most of all: SURPRISED because of the stark difference between my cardiologist’s silent waiting room and the Breast Imaging Clinic! My first thought at the time was maybe it’s because a breast imaging clinic is all (or mostly) women – but that Notre Dame survey reported dismal environment and they were all women too – so the reason might be more than just the demographics.
I will find out my biopsy results tomorrow at 1:30. So I plan to have a good sleep tonight! Stay tuned. . . ❤️
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Hi Carolyn,
I have spent quite a lot of time in waiting rooms through the years, too. What I do while sitting in them, is study people. I find it fascinating. It’s a unique sort of people watching that happens in waiting rooms, especially in cancer waiting rooms, and probably in cardiac waiting rooms as well.
One distinction I’ll make, in my case anyway, is that the breast imaging center was/is very different from the general cancer waiting room. At the imaging center I went to for my ultrasound and biopsy, everything was set up to be calming: Coffee available, books to read, soft music, stained-glass art hanging in the windows, mahogany cabinetry, and on and on. I wrote about it in my book, Cancer Was Not a Gift.
The regular cancer waiting room, on the other hand, had/has none of that. I’ve never thought about this difference in waiting rooms until I read this piece. Very interesting, to say the least.
Maybe because I’m an introvert, I don’t really care about interacting with others all that much while in any kind of waiting room. I guess I sort of withdraw and prefer to be left alone and get it all over with. I don’t go to any medical appointment looking for camaraderie. Maybe I’m just weird that way. Having said that, I certainly prefer the atmosphere in the breast imaging center.
Enough with my rambling, though. Please know I am thinking about you as you wait for that pathology report. I will be here no matter what it reveals. I am hoping it’s all good news.
Oh, one more thing regarding kindness like the kind expressed by your nurse practitioner… I got a handwritten note from the staff after my biopsy. It was so nice to get those words of validation and encouragement. So yeah, breast imaging centers and how they’re set up just might be on to something after all.
Love and hugs. x
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Hi Nancy – a handwritten note! That’s wonderful!
I am surprised to learn that your imaging clinic experience was so nice, compared to your general cancer room experience. We need that CALMING efforts in both places!! You’d think we need it more when treatment actually starts!
I too enjoy people-watching – although in my cardiologist’s waiting room it has to be done furtively – quick little glances that aren’t interpreted as staring because nobody else’s eyes are scanning the room!
❤️
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The only area where I have seen that sort of open friendliness is in cardiac rehab (round 2 for me now), which admittedly is not a waiting room but an activity room.
My guess is that it starts with a cheerful, welcoming receptionist and spreads from there. And a culture is built over time. (“Does anyone need water? Is it warm enough in here?). I would love to see it – though not as a patient.
PS hope pathology was kind to you.
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Hi Dr. Anne – such a good point about rehab! I had to laugh when I read your comment, which reminded me of my own rehab days. I was the only woman in our group, and the youngest by at least three decades! My new rehab friends all happened to be avid golfers who talked nonstop about golf-golf-golf. There was lots of happy chatting – and I learned more than I ever thought possible about golf!
YES! A cheerful welcoming receptionist should be a key hiring criterion – yet sadly, many are neither cheerful nor welcoming – so it’s a delight when we encounter those who are those things. Waiting room conditions are definitely culture-based.
Take care. . .❤️
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Yes, in my first cardiac rehab I was the only woman. This time there are several other women. Changing disease demographic or more referrals? Hoping for the latter.
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Oh I hope so too, Dr. Anne – I think cardiologists are finally getting the message. I wrote ““Failure to refer: why are doctors ignoring cardiac rehab?” ELEVEN YEARS AGO!
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I remember, and I remind women every time I hear that they are heart patients. And I remind every cardiologist that I see as well.
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You are a one-woman recruitment genius! Cardiac Rehabilitation is considered by every cardiology society worldwide as a Class 1 guideline (it’s right up there with routine statin prescriptions) which should mean that every doc will routinely be prescribing this with the same regularity they prescribe statins. CR was a life-saver for me… ❤️
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Carolyn, this is a really thought-provoking post. I’ve never considered the difference between waiting room atmospheres like that.
The idea that a waiting room can foster community and support in the face of anxiety is really powerful. It makes you wonder how we can bring that sense of connection to other medical settings.
Marie Ennis-O’Connor
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Hello Marie – that’s exactly what I wondered, too. If our Breast Imaging Clinic can foster that sense of “community and support in the face of anxiety” – why can’t my cardiologist’s waiting room do the same?
Does it come from the top down, planning for a more welcoming atmosphere? Or is it because breast imaging waiting rooms are almost always filled with women? The actual appearance of the waiting room I describe (simple chairs, small space in a windowless room) is very basic, so it can’t just be the physical appearance or decor (although I’m sure nice surroundings would help!
Or is this difference more like my bus-riding observation, in which the people ahead of us “teach” others to be polite to the driver?
I thought the Notre Dame report on their own breast cancer centre waiting room was heartbreaking: “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.”
I have sat in many waiting rooms that could be described exactly like that! And the Notre Dame waiting room -like ours – was also filled with women – so it’s not necessarily the demographics that count.
It’s a mystery – it would be lovely to solve that mystery and share it with all other medical waiting rooms!
Take care. . .❤️
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