(EOVA) Geek Club

People participate in journal clubs or book clubs. Geek Club is my affectionate term for documenting summaries of all the geeky stuff I read. I work as a physiatrist at the East Orange VA hospital in NJ. This may also serve as a resource for the residents who rotate through there.

Tuesday, December 25, 2007

Most Patients Prefer Their Physicians to Greet Them With a Handshake and Introduction

Arch Intern Med. 2007;167:1172-1176.

"Physicians should be encouraged to shake hands with patients but remain sensitive to nonverbal cues that might indicate whether patients are open to this behavior," the authors write. "Given the diversity of opinion regarding the use of names, coupled with national patient safety recommendations concerning patient identification, we suggest that physicians initially use patients' first and last names and introduce themselves using their own first and last names. Greetings create a first impression that may extend far beyond what is conventionally seen as 'bedside manner.'"...More women than men and African Americans than whites preferred that the physicians use both first and last names when introducing him or herself...Other physician characteristics of value to patients interviewed by telephone included smiling, being friendly, being warm and respectful, and being attentive and calm.
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3 comments:

Gautam Malhotra said...

A comment from a friend who wishes to remain anonymous:

"This is useful information.

As a clinician, however, I am always concerned about the potential conflict between what the patient prefers and what the patient needs.

Most of the time, wants and needs are in alignment with one another- certainly there are reasons to both want and need a cordial relationship between the patient and doctor.

There are certainly other circumstances, however, when wants and needs are not in alignment. For example, what of the anxious mother whose child has what is likely a viral ear infection. Most often, what she wants are antibiotics, but what she needs is reassurance.

Circumstances such as those may seem remote from a discussion on how to greet a patient. But they are part of a more global conversation- what is the nature of the interaction between patient and physician?

In my opinion, the trend is toward patient-centered care, and focusing on the wants of patients. Certainly medicine could do a better job in being better customer service oriented.

However, I am concerned that while patient-centered care is important, from a global perspective, outcome-centered care is an even more pressing, and dare I say, noble goal.

One danger of care that is overly patient-oriented is that decisions made on an individual level have a negative consequence on a global level. If the focus is always on the patient in front of you, it will introduce systematic bias that will create systematic crises.

Examples:
1. The over-prescription of antibiotics. It has been well-documented that antibiotics are over prescribed for many conditions, including ear infections and upper respiratory infections. One reason is that the patient care is too patient oriented- clinicians are focused on the patient in front of them on focusing on the patient's wants, rather than the patient's and societal needs.

2. Spine MRIs. Again, many patients come in wanting an MRI, despite the very high false positive rate. This in turn can lead to negative consequences for the patient (including unneccessary surgery, and the negative sequelae of cost and sometimes disability).

3. Mammograms in young women. This is similar to spine MRIs. There is high false positive rate, and those false positives lead to a financially and emotionally expensive pathway of biopsies and potential surgeries.

Again, this may all seem tangential. However, the outcome cited at the end of the abstract of patient preference to me seems like a less than ideal outcome measure. I don't know that physicians should govern their behaviour based on the initial wants of a patient. I would prefer that the outcome of interactions be judged based on the patient's sense of long term wellness and their health outcomes."

December 27, 2007 at 7:15 PM
Gautam Malhotra said...

this would be my response to my friend.

your general point is well taken if I understand correctly. Basically what you're saying is that we should make sure to keep the patient's needs our first priorityrather than their desires. They are not customers. They are people who are in need of our help. Given that I agree with you on that point, I looked at this study differently. I don't feel that I absolutely need to follow the advice or the conclusions that arose from this study anymore than I feel I need to follow the advice or conclusions that arise from any other studies. Additionally, my population of American veterans respond very differently from other populations with regard to what makes them comfortable. Therefore, just like any other study, it may or may not inform how I practiced medicine. In fact, for the past two days, I have been trying to greet my patients the way they said. My patients seem to respond very well to warm greeting, "Mr." followed by their last name, and me telling them just my last name. In this case, it seems to make sense because my name is not very recognizable nor easy for them to understand the first time they hear it. And in the VA system they are used to being referred to as a last name and last four digits of their Social Security number. Thank you for sharing your thoughts.

December 27, 2007 at 7:26 PM
BlogJogger said...

Remember the golden rule: treat others the way you want to be treated.

But you mustn't forget the platinum rule: treat others the way they want to be treated.

January 4, 2008 at 7:06 PM

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