Dr. Michael Kahn, from our Department of Pyschiatry, has published an article in the New England Journal of Medicine that suggests that doctors enhance their relationship with patients when they deal with patients in a polite manner. Here is a summary on the AOL web site, along with a poll on the issue. I like this summary: Etiquette-based medicine . . . "would put professionalism and patient satisfaction at the center of the clinical encounter and bring back some of the elements of ritual that have always been an important part of the healing profession."
NEJM has published the entire article as freely available to the public here. This is a very polite thing for them to have done, and I thank them.
I once was referred to a psychiatrist who did not make eye contact when introducing herself to me, and who awkwardly and reluctantly shook my hand when I offered it as I introduced myself -the relationship never did work out!!
ReplyDeleteRecently had my first visit with a specialist MD who has only been licensed a couple of years - she did get thru the items on this list in a basic fashion, then proceeded to spend the next 10 minutes looking at the computer and not at me - she's technically competent, but not someone I would hurry to see again, to be honest.
My BIDMC primary is big on the computer too, but I have seen him for years and feel comfortable just stopping my conversation til his focus comes back to me and not the computer. It's been a good way to redirect his focus without having it be confrontational. He's generall pretty good at the relationship issues, which is very important to me. And, his enthusiastic use of PatientSite definitely helps communication and allows me to get my agenda on the table.
I think that a lot of noncompliance issues for patients are based in a feeling that the doctor doesn't know what they are talking about (meaning either MD doesn't know the subject area or doesn't know the patient).
It's hard to believe that your doctor can really know a lot about your heart when he or she looks like your son did just a few years ago in high school! This is often the initial reaction for patients, and if there is a lack of what is perceived as 'respect' or 'manners' in the initial encounter, the medical care provider has put him or herself at a real disadvantage in establishing credibility with a patient and family.
Keep on teaching basic manners - it DOES make a huge difference in the satisfaction level for the people on both sides of every interaction.
Thanks for listening.
I read the article in the NEJM and at first thought it was either meant to be funny or ironic.
ReplyDeleteIf a doctor is unable to bear a patient's suffering or have compassion, isn't that like providing treatment with your right brain tied behind your back? And I don't think that a robotic expression of manners will provide a satisfactory patient experience. That requires some degree, even a minor one, of real connection.
Here's a post I wrote about this article:
http://insicknessinhealth.blogspot.com/2008/05/etiquette-based-medicine.html
Paul, I was teaching yesterday in Lucian Leape's class at the Harvard School of Public Health. The topic was the Power of Patient and Family Engagement. The group struggled with the challenges of engagement and listening, as crucial they are, in the context of busy workloads, cultures that don't value either, and the complexities of practice. We talked a lot about leaderships' responsibility to set an expectation (it's not an "if" discussion anymore), provide resources and support, and hold people accountability. We also acknowledged that leadership had to happen everywhere grounded in respectful listening. I only wish I had this wonderful article with me yesterday. Imagine the impact we could have if EVERYONE in healthcare committed to this checklist. I've sent the article off to Lucian for the class and send a Bravo to Michael (can you forward). And yes, the checklist is now a slide for my next presentation on the topic.
ReplyDeleteWith gratitude, Jim Conway, SVP, IHI