The unspoken work of general practitioner receptionists: A re-examination of emotion management in primary care

Abstract

Dealing with illness, recovery and death require health care workers to manage not only their own emotions, but also the emotions of those around them. While there is evidence to suggest that core occupations such as nursing are well versed in the nature of and need for such work, little is known about the requirements for emotion management on the part of front-line administrative staff. In response, findings from a three-year ethnographic study of UK general practice, suggest that as a first-point-of-contact in the English health care system GP receptionists are called upon to perform complex forms of emotion management pursuant to facilitating efficacious care. Two new emotion management techniques are identified: (1) emotional neutrality, and (2) emotion switching, indicating a need to extend emotion management research beyond core health occupations, while at the same time reconsidering the variety and complexity of the techniques used by ancillary workers.

Introduction

Receptionists have become central to the functioning of general medical practices, so much so that Arber and Sawyer (1985) note that it is no longer appropriate to talk of a dyadic relationship between doctor and patient, this having been superseded by the triumviri of doctor–receptionist–patient in primary care. While doctors have been observed to benefit from this change in terms of assistance with service co-ordination and demand moderation (Arber and Sawyer, 1985, Copeman and Van Zwanenberg, 1988, Gallagher et al., 2001) the response from patients has been more ambivalent; with the receptionist as administrative intermediary being stereotyped as an uncaring barrier to much needed health care (Arber & Sawyer, 1985). The above implies that there is little recognition of the place and performance of emotional labour (Mann, 2005) in such front-line health care. This is potentially significant given that receptionists are administrative gatekeepers to General Practitioners (GPs) who, in the English health care system, continue to be the primary medical gatekeepers to NHS care – a position recently strengthened by reform (DH, 2010). This paper considers the extent to which GP receptionists are required to perform emotion management and the implications this has on the patient journey through primary care. We begin with a brief review of the extant literature on emotion management.

In her landmark thesis Hochschild (1983) compares the instrumental use of flight attendants’ emotions in the service sector with that of labourers in the secondary sector. She notes that in the former case the ‘the emotional style of offering’ is part of the service itself as flight attendant’s emotions are commodified by the airline in exchange for a wage, just as manual workers are paid for their physical labour power by factory owners (Hochschild, 1983: 5). Emotion management is therefore defined as the ability ‘to induce or suppress feeling in order to sustain the outward countenance that produces the proper state of mind in others’ (Hochschild, 1983: 7).

This work has been usefully extended by Korczynski, 2003, Korczynski, 2009 distinction between empathetic and antipathetic emotion management (often emotional labour where performed for a wage). Korczynski classifies empathetic emotional labour as that which is intended to produce a positive emotional state in others, such as the sense of happiness, safety or care that may be associated with the work of nurses, cabin crew or hairdressers. By contrast, antipathetic emotional labour is intended to produce a negative emotional state in others, as in the fear and insecurity potentially employed by debt collectors, or prison guards

In 2009, Korczynski developed the empathetic–antipathetic dichotomy to propose that service roles should be differentiated on the basis of what he calls the ‘substantive nature of the emotional bearing enacted by the worker to the customer’ (2009:957, emphasis added), that is to say the degree to which the worker’s private emotions are intertwined with the customer. Similar to Rafaeli & Sutton’s (1987) faking in good and bad faith, Korczynski (2009) suggests a ‘continuum’ of ‘emotional bearing’, with the two extremes being a ‘purely instrumental approach’ and a ‘caring approach’. The instrumental approach requires workers to have little emotional engagement with the customer beyond the commercial interaction, whilst the ‘caring approach’ is characterised by a “deep level of humanity enacted by workers towards service-recipients (Bolton & Houlihan, 2005)” (Korczynski, 2009: 958).

Thus, Korczynski’s work begins to move us towards the possibility of considering emotion management as a relational process of commission, performance and consumption; the experience of which can be positive or negative. Moreover it serves as a useful backdrop to emergent debates on emotional labour’s relationship with health care generally, and our concern with the service role of receptionists specifically.

In spite of some significant contributions to the emotional labour literature stemming from research in health care (notable examples include James, 1989, Smith, 1992, Bolton, 2005, Theodosius, 2008), at present there is no equivalent of this research for those working in health administration. The result is a narrow picture of the place and performance of emotional labour within the health care sector as a whole (Mann, 2005). It is in response to this lack that the present paper considers the emotional labour of GP receptionists.