Doctor learns that simple smile is good medicine

It was 6:30 a.m., and already I was grumpy, walking alone down a long, shiny corridor into Vanderbilt University Hospital.

In the distance, an orderly pushed a woman in a wheelchair toward me — my only company in the early-morning quiet before what would surely be another hectic day.

As the woman came closer, I could see she was 60-something, bright-eyed, frail and balding. Her thin frame was crooked in the wheelchair. She appeared to be suffering from cancer and losing the battle.

What did she see? Likely a snarling, stressed-out young doctor consumed with selfimportance.

What happened next shook me to my core and left a vivid, lifelong impression that I have contemplated many times in

Dr. John Barnard

the decades since.

As we passed, our eyes met, and this dear woman, her body racked with the final stages of a fatal illness, smiled the biggest, most beautiful, reassuring and all-knowing smile one could ever imagine.

In an instant, my agitation vanished as I realized what had just happened — a cancer patient had just skillfully treated a doctor.

This poignant, humbling memory has been a gift in my life as a physician. It was reinforced a few years later when the tables were turned and I was a patient, sitting in the large, bustling waiting area of an X-ray department.

Alone and nervous, I was struck by how the busy staff took little notice of the patients. No greeting, no eye contact, no smile.

As a result of these experiences, I resolved to smile more often, especially with patients and families. It is not my nature to smile that much, so I have to think about it. But I think I have improved.

This is supposed to be a column about research, but the intersection between humanity and medicine is not necessarily easy to investigate.

For example, there isn’t a lot of scientific work on smiling. But there are interesting questions about the developmental origins of smiling, and there are fascinating questions about what makes a smile so psychologically powerful.

Much of the research on smiling focuses on the earliest maternal-infant interactions. MRI studies show that smiling infants awaken reward-processing areas of their mother’s brain.

And infants seem to prefer a smile to a neutral facial expression. Perhaps this early, strong emotional bond primes us to value a smile in fundamentally important ways for the rest of our lives.

Research in older individuals suggests that we are more likely to remember someone’s name if they are smiling when an introduction is made. And research published a few years ago in the British Medical Journal indicates that patients strongly prefer smiling physicians to those who exhibit a more-neutral facial expression.

All of this research might seem obvious, but the truth is we do not smile enough in our era of high-tech medicine.

We would do well to remember that there is within us a low-tech approach with a powerful capacity to influence health and well-being. And we might just radically change someone’s day in a way that causes him or her to fondly remember it forever.

Dr. John Barnard is president of the Research Institute at Nationwide Children’s Hospital.