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For the Smile-Challenged: Why a Smile Matters
by Susan Keane Baker

If you work in a health care setting, your work must be done quickly and accurately. The importance of focusing on the serious nature of your responsibilities makes it easy to forget to smile. You've probably heard people who have grown smile-challenged say with great condescension in their voices: "Oh. smile school." And then offer up their best fake smile. Beware of the Botox smile - the smile that doesn't involve the muscles around your eyes. Women are better at giving those smiles, and they are better at detecting them too.

Genuine smiles are important for many reasons:

  1. Without a welcoming smile, your patient may decide "this isn't going to be good." And because people want to be right about their assumptions, they then look for, and focus on, any additional evidence that they should be dissatisfied with the experience.
  2. You can be the hardest working and nicest person in the organization, but if your patients don't see you that way, you will be less effective.
  3. "The importance of a smile and of face-to-face contact cannot be underestimated. Smiles are incredibly contagious - like yawns, if you smile, the other person usually smiles back. When someone important smiles at us and we smile back, brain chemistry changes and powerful emotions are triggered" says British psychologist Dr.David Lewis. As a result, we feel more optimistic, happy and motivated. Who doesn't want optimistic, happy and motivated patients?
  4. A smile gives people something to enjoy. British researchers found that receiving a smile could give more pleasure than sex or even eating chocolate. And receiving a smile from a friend or relative generated much higher levels of stimulation to the brain and the heart than being given money or having a cigarette.
  5. You enjoy happy moments more when you smile. In a research study, participants were either prevented or encouraged to smile by being instructed how to hold a pencil in their mouths. Those who held a pencil in their teeth and thus were able to smile rated cartoons as funnier than did those who held the pencil in their lips and thus could not smile (Davis & Palladino, 2000).
  6. Dacher Keltner, a psychology professor at the University of California in Berkeley, released a study of photographs of women in college yearbooks dating back to the 1960s in which he separated the Duchenne smilers from the artfully posed. Duchenne smilers have involvement of the eyes along with smiling lips. Researchers tracked the women down and found that those who had smiled most happily at college overwhelmingly tended to have had the happiest lives since they had graduated. "It's a virtuous circle," Keltner concluded. "Happy smiley people cheer others up around them, which in turn makes them more stable and less prone to depression or divorce than those who faked it in their yearbooks."

The most dramatic illustration of a smile came to me in 2003, as I was listening to National Public Radio:

    Early in the invasion of Iraq, American forces entered the city of Najaf - a holy site. They wanted to meet with the Gran Aytollah Ali Shistani, who had ordered civilians not to resist American soldiers the day before. An angry crowd of hundreds of civilians gathered with the mistaken impression that the Americans were going to destroy a holy shrine. The crowd shouted and waved their arms threateningly as they pressed forward toward the armed soldiers. Jim Lacey of Time Magazine was there and witnessed the standoff. He said that it could have easily turned disastrous if not for the quick thinking of Lt. Colonel Christopher Hughes. Colonel Hughes picked up a loudspeaker and said: "No slack soldiers" - the nickname for the 2nd Battalion 327s. "No slack soldiers take a knee." Almost instantly every soldier was down on one knee. His next order: "All no slack soldiers point your weapons to the ground." His third order was "All no slack solidiers, smile." That one act of taking a knew, pointing their rifles down and the smile - made the crowd understand that the soldiers were not there to harm and the crowed changed instantly in response and people started smiling again and patting Americans on the back.

I think Colonel Hughes knew what Fred Rogers knew: That people long to be accepted for who they are. Although Mr. Rogers couldn't physically touch those who watched his television program, he did touch millions of people emotionally. His reassuring, "I like you just the way you are" smile had a great deal to do with the impact he had.

A smile benefits you and your patient, and that's why it matters.


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