When we look back to the state of medical practice at the beginning of the 20th century, there's a lot of good advice for psychologists today, especially about where offices should be located and how they should look. Medicine was a competitive business at the end of the 19th and beginning of the 20th century. There were many more doctors than were needed, and physicians were advised not to refer patients for fear that they would lose income. For that reason, factors beyond diagnosis and treatment were concerns; how you presented yourself through your surroundings made an impact on patients (and your income). That claim could be made for practitioners today.
As an environmental psychologist, an interest of mine is the kind of offices these early physicians had and where they were advised to locate them. When my paternal grandfather practiced medicine in Clarksburg, West Virginia beginning in 1901, there was very little bureaucratic oversight; practice was either in a physician's home or a small office; many practitioners were not yet licensed. His major means of transportation was a horse, later replaced by a bicycle because it was more convenient than walking to the barn and waking the night attendant to saddle the horse for night calls.
As doctors like my paternal and maternal grandfathers (most physicians at the time were men) began practice at the beginning of the 20th century, there were a number of advice manuals and journals, ranging from Cathell's 1882 volume "The Physician Himself and What He Should Add to His Scientific Acquirements," Wood's 1903 "Dollars to Doctors or Diplomacy and Prosperity in Medical Practice," and Mathews' 1905 "How to Succeed in the Practice of Medicine," to journals such as Albright's the "Office Practitioner."
With regard to the location of the office, Cathell (1882) emphasized being near a major artery, but not on one, arguing that your practice would be negatively affected if the location and appearance of the office were deficient. For Cathell, a location on a street rarely frequented would suggest that the practitioner wasn't sufficiently motivated to succeed or didn't trust his skills.
Beyond the importance of location, the appearance of the office itself mattered. The author of an article that appeared in the "Office Practitioner" in 1905 entitled "How to conduct your office" drives home the point that the practitioner's surroundings make an impression. In this article the author commented on the disorder and dirt (including cobwebs hanging from the ceiling) he found in a physician's office and that physician's bewilderment about how few patients he saw in his small practice. Then as now, many practitioners do not make the connection between the appearance of the physical environment and people's impressions of the practitioner as competent.
This poorly kempt office with cobwebs was the kind described in the novel "Arrowsmith," written by Sinclair Lewis in 1925. A number of historians of American medicine (e.g., Charles E. Rosenberg) have written about Martin Arrowsmith, a physician and protagonist of the novel. Lewis writes in great detail about the three rooms that were the domain of Doc Vickerson, for whom Arrowsmith initially worked. Doc Vickerson's office was set above a clothing store, facing Main Street, a second-story location that was common at the time, and the central room was multi-purpose: for business, consultation, surgery, poker, relaxing, and for storing his fishing-tackle and guns. One had the impression that cleanliness was not the highest priority in this room.
Much of the advice from journals such as Albright's the "Office Practitioner" sounds surprisingly current, mentioning keeping the office orderly and clean, displaying a diploma and certificates of special training, displaying pictures related to the profession, and furnishing the waiting room in a manner similar to a parlor. As it was still common for doctors to see patients in the patients' own homes at the turn into the 20th c., the prescription of furnishing a waiting room like a parlor thus makes sense. What could be more comforting to a patient than a waiting room that looks like "home?"
With regard to the décor of the office, not everyone subscribed to the idea of decorations that were home-like. In particular, in those early years many physicians displayed professional "relics." Writing about Doc Vickerson's office in the book "Arrowsmith," Lewis describes the collection of zoological specimens and medical curiosities. Such items as the human skeleton, anatomical specimens, and mementos from dissections the physician performed were described by Cathell as appropriate and useful, to remind the patient of the physician's professional status. Not everyone is comfortable with such displays or even with anatomical posters.
What, then, should the practitioner display in his or her office? Consider the sage advice from author Wood in a chapter entitled "Some Essential Don'ts" in the classic "Dollars to Doctors" written in 1903. The author clearly appreciates the negative effect that displays of medical curiosities, specimens, and implements can have on the patient, recognizing that patients don't want to be reminded of anything associated with death. The place for instruments, he argues, may be in an exhibit at a fair on in a shop window, not in a doctor's office, where there is too strong an association with the idea of cutting and surgery. Rather, what Wood suggests is a display of books, which he notes inspire confidence and reflect positively on the physician's acquisition of knowledge.
Today, rather than needing to be reminded of the physician's specialty by the display of artifacts, patients are often scared of such reminders, whether anatomical posters of the digestive system, photographs of skin lesions in a dermatologist's office, or even your own dental x-rays, now digitally staring you in the face during most routine dental cleanings.
In some research on doctors' offices, students were queried about the office where they regularly received care and were asked to provide anecdotes about favorable and unfavorable impressions of the physical surroundings. One of the most common responses was that people did not like anatomical diagrams or the display of detailed medical information. Students said they preferred popular magazines and depictions of things to distract them, not to remind them of the impending exam, vaccination, or their symptoms. While factually informative, the display of medical information did not make the room feel inviting or welcoming. As one said, "In-depth medical diagrams freak me out" while another commented "I hate the examination room - white walls, medical themed wallpaper, posters of body parts, and pamphlets on diseases - yuck! It makes me feel so uncomfortable and I hate anxiously reading about AIDS or strep as I wait for the doctor to return."
From the advice available to early medical practitioners and the critiques offered by students today, psychologists can take away how important it is to look critically at the surroundings in which they practice; to think about the impact of location (near but not necessarily on a major artery); the comfort of the furniture they provide (home-like); and the presence of positive distractions like popular magazines. As research has indicated, patients do make a connection between the appearance of the physical environment and the practitioner's competence.
