title: The power of the pen: how to make physicians more friendly and patients more attractive.
abstract: BACKGROUND
  Studies have shown that patients' subjective perceptions of physicians' competence and friendliness are relevant aspects of a successful treatment, influencing patients' well-being and trust in the physician. Psychological research has repeatedly shown that unconsciously contracting muscles that are usually used to smile can intensify and even elicit positive feelings (known as facial feedback). Empirical evidence also suggests that a smiling person is favourably judged by others with respect to attractiveness and trustworthiness.
  
  
  OBJECTIVE
  This study's purpose was to investigate how an induced muscle contraction, similar to that of a smile, affects physicians' interactions with a standardised patient. It was expected that the 'smile intervention' would affect physicians' and patients' perceptions, resulting in higher ratings of the friendliness and attractiveness of physicians in the intervention group.
  
  
  METHODS
  Twenty physicians participated in the randomised controlled study (10 male, 10 female). Physicians were randomly assigned to one of two conditions: an intervention group (performing an easy cognitive task while smiling; n = 11) or a control group (performing an easy cognitive task without smiling; n = 9). Afterwards, physicians had a 5-minute consultation with a standardised patient. This consultation was subsequently rated by physicians, the patient and an external rater using 10-point Likert scales.
  
  
  RESULTS
  Physicians in the intervention group were rated as significantly friendlier by the external rater (mean 7.81 versus 7.11; p = 0.097, η2= 0.15). In addition, physicians in the intervention group rated the patient as significantly more attractive (mean 6.91 versus 4.78; p = 0.017; η2= 0.28).
  
  
  CONCLUSIONS
  Our results suggest that physicians can influence their friendliness and their perception of patients' attractiveness. Thereby the 'power of pen' can be an efficient method for making the hospital a friendlier place.
authors.affiliation: Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der Universität München (LMU), Munich, Germany.
authors.forename: Nurith
authors.initials: N
authors.lastname: Epstein
authors.affiliation: Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der Universität München (LMU), Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Brendel
authors.affiliation: Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der Universität München (LMU), Munich, Germany.
authors.forename: Inga
authors.initials: I
authors.lastname: Hege
authors.affiliation: Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der Universität München (LMU), Munich, Germany.
authors.forename: Diana L
authors.initials: DL
authors.lastname: Ouellette
authors.affiliation: Medizinische Klinik und Poliklinik VI, Klinikum der Universität München (LMU), Munich, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Schmidmaier
authors.affiliation: Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der Universität München (LMU), Munich, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Kiesewetter
mesh_terms: D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D016544:Patient Simulation; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D012904:Smiling