When was the last time you sat down to talk to your patient? After you tell the patient your name, do you tell them what your role is? If not, maybe you should reconsider. In 2008, Dr. Kahn published his etiquette checklist in the New England Journal of Medicine as a simple way for doctors (and medical students) to approach hospitalized patients.
1. Ask permission to enter the room; wait for an answer.
2. Introduce yourself, showing ID badge.
3. Shake hands (wear glove if needed).
4. Sit down. Smile if appropriate.
5. Briefly explain your role on the team.
6. Ask the patient how he or she is feeling about being in the hospital.
Kahn M. Etiquette-Based Medicine. N Engl J Med. 2008; 358: 1988-1989.
A study published in the Journal of Hospital Medicine looked at whether these behaviors are actually practiced. Their study involved 29 first year Internal Medicine residents who were observed in over 700 patient interactions. They found that residents self-reported that they introduced themselves to patients about 80% of the time, but were only observed to do so 40% of the time. They also estimated that they sat down 58% of the time, but were observed to do so only 9%. While it may take an extra minute to locate a chair and sit down, if you’re going to be in the room with the patient for more than a few minutes perhaps you should consider it. Taking the time to sit is a nonverbal cue for the patient to feel like he or she has your full attention and time. Also, when you stand over a patient, it can make him or her feel uncomfortable.
Block L et al. Do internal medicine interns practice etiquette-based communication? A critical look at the inpatient encounter. J Hosp Med. 2013; 8(11): 631-4.
Perhaps you’ll join me and make it one of your New Year’s resolutions to practice etiquette-based medicine.