Monday, May 12, 2008

"Etiquette-based medicine"

Patients ideally deserve to have a compassionate
doctor, but might they be satisfied with one who is
simply well-behaved? ...A doctor who has trouble feeling
compassion for or even recognizing a patient's suffering
can nevertheless behave in certain specified ways that
will result in the patient's feeling well treated..
---Michael Kahn, MD

Dr. Kahn calls for a good manners curriculum in medical education in the latest edition of the New England Journal of Medicine.(1) He provides an example of a behavioral checklist that clinicians should follow to promote civility and respect in our patient encounters, including:
  1. Introduce yourself.
  2. Shake hands.
  3. Sit down.
  4. Smile if appropriate.
I'm sure you've all had encounters with physicians who were less than polite. My Mom's first doctor at the nursing home, shortly before I fired him, spent five minutes in her room during which he never looked at her once nor addressed a single remark to her. I saw a dermatologist a few years back who walked in one door of the exam room, moved slowly past me looking closely if briefly at the area of concern on my forearm, then scurried out the door at the other end of the room. Period. End of encounter.

I agree with Dr. Kahn. If you can't teach all medical students compassion, pass along a few basic rules of etiquette, and train them to shake hands and sit a spell.
(1)Kahn, MK. Etiquette-Based Medicine. NEJM. Volume 358:1988-1989.


Reality Man said...

You will recall the former internist of mine who would shake hands without removing the ballpoint pen from his hand.

Ruth said...

How true! A little courtesy goes a long way. The rudest doctors I have met have been surgeons (not all surgeons are rude, thank goodness!) The doctors I work with at our rehab hospital are tops in compassion and manners. They are truly loved by patients and staff alike.(as I am sure you are too!)

Cilicious said...

For the most part, I've had really good luck with very courteous, attentive docs.
But I've met the occasional distracted, inconsiderate types.
At first I was intimidated, but then realized this behavior is *not okay* and I don't have to put up with it.
...Unless my health insurance says so...:(

Anonymous said...

To this MD etiquette primer I would add: If you are running way late, it would be nice if you would say something like, "Sorry I'm running so late today!!" I love my internist, but always wait at least 1/2 hour in the waiting room and then an inordinate amount of time in the exam room after being told, "She'll be right in." Drives me nuts. On the flip side, I never feel rushed by her during a visit. I just know that somebody else is cooling their heels in the waiting area or exam room while I tell my tale of woe.

Mauigirl said...

My doctor is so cool. She'll sit and listen to you as long as you have something to say. And she'll even deign to talk about something other than symptoms or medical issues from time to time - briefly, but enough to feel as if we have a relationship (we're both liberal Democrats so you can imagine where some of our conversations go). She listens to what I say, she doesn't pooh-pooh anything I bring up, she keeps me calm.

I wonder if this is more apt to be the case with female doctors? I hate to be gender-biased but now that both my gynecologist and primary care physician are women, I think I'll never go back to a male doctor. I had some nice ones - but the women just seem much more compassionate and easier to talk to. I do like my male dermatologist - but he's the second one I went to; the first was terrible when it came to bedside manner!

Mauigirl said...

Oh, and my oncologist and surgeon are both men. The oncologist is a good listener and he's easy to talk to; the other one is very polite, very pleasant, but I know now not to ask too many questions. I get the feeling he doesn't like being second-guessed on anything.

Tiffany said...

It still baffles me that this is even a topic of discussion!

The elementary nature of this "check list" contrasted with the magnitude of a doctor's responsibilities (you know, that saving lives thing)--it just does not compute inside my little patient's brain!

On a personal note, I can't wait to learn more about your blog book! So exciting!!! :)