Not long ago, the receptionist on the hospital floor where I work went on a family leave. Calm and with a wisecracking wit that she attributes to her New Jersey roots, she had worked at the hospital for years and knew better than anyone how to make things happen in the system.  What doctors and nurses missed most when she was gone, though, was her ability to soothe emotional family members, intuit medical emergencies on the phone and cut off rude doctors — then tirelessly repeat that good work dozens of times over the course of a day.  When she got back from her leave, I told her how much all of us had missed her. ”There are some doctors and nurses who don’t think much of what people like me do,” she laughed. ”But we are the first ones to see and take care of everything.”

While much has been written about the role of doctors, nurses and other clinicians in the care of patients and their families, little attention has been paid to those individuals who make up the very front lines of health care. In almost every clinical practice, office receptionists and the professionals who do comparable work in hospitals, the ward clerks and unit secretaries, are the first people patients see. But serious research on their interactions with patients has been sparse at best.

Now the journal Social Science and Medicine has published a new study on the work of this group of professionals. Despite the stereotype that many receptionists bear as mere ”gatekeepers” or even ”the dragon behind the desk,” the study found that their responsibilities extend far beyond administrative duties. Ward clerks and office receptionists are a vital part of patient care.

Over the course of three years, Jenna Ward, lead author of the study and a lecturer in organization studies at the York Management School of the University of York in England, embedded herself in general practice offices and observed and interviewed nearly 30 office receptionists. She found that in addition to their administrative work, receptionists had to deal directly with as many as 70 people during a single day. Their emotionally challenging work ranged from confirming a prescription with an angry patient, to congratulating a new mother, to consoling a man whose wife had just died, to helping a mentally ill patient make an appointment.

The demands changed from minute to minute and were often unpredictable. But one thing was certain: A significant portion of their work involved managing the emotions and care of patients and families.

”Receptionists are a key part of the relationship between patients and doctors,” Dr. Ward said. ”We should be thinking of the relationship not as a two-way one between doctor and patient or nurse and patient, but as a three-way relationship among clinician, patient and receptionist.”

Dr. Ward observed that the most experienced and successful receptionists could rapidly change emotions to meet the patient’s needs. For example, seconds after one of the receptionists confided to another how sad she was about the accidental death of a young patient, the office telephone rang. The receptionist immediately collected herself, then answered the phone in a warm and cheery way. During a mix-up over appointment times, another receptionist responded calmly to an elderly patient who had begun shouting racial epithets, helping to defuse the situation.

”It’s not that the receptionists don’t feel anything; it’s just that they may be mirroring the kind of ‘objective’ behavior that doctors are taught in order to protect themselves,” Dr. Ward said.

But this detachment can also backfire. In an effort to protect doctors from being inundated with patient visits and requests, many of the receptionists relied on emotional distancing to deal with upset patients, a strategy that sometimes only angered patients further. ”In a lot of people’s minds, the receptionist is barring access to primary care,” Dr. Ward said. ”But the receptionists see themselves in the very difficult position of having to deal with all the emotions of the patients while remaining responsible for the practice and protecting their practitioners.”

Dr. Ward believes that with more recognition and support for the emotional work receptionists do, such misunderstandings and antagonistic interactions could be avoided. Practices, for example, could make more explicit the fact that any requests to see a clinician would be fulfilled within 72 hours rather than 24. Moreover, those who become receptionists could receive training on handling not only the administrative but also the emotional aspects of their work.

”Right now, when you employ people as receptionists, it’s kind of a Russian roulette as to how much emphasis they place on the emotional work,” Dr. Ward said. ”If it were more integrated into the culture – health care as being doctors, nurses and administrative staff – we might encourage people to perform these emotional tasks well.”

”Patient care is a holistic social process,” Dr. Ward added. ”And those on the front line can be a crucial part of that holistic treatment.”