Doctors in Residency Fail Tests of Common Courtesy

Cheryl Clark, for HealthLeaders Media , October 24, 2013

The five actions are components of what is termed "etiquette-based medicine" by Michael Kahn, MD, in a 2008 article in the New England Journal of Medicine.

Interns performed all five of these behaviors during only 4% of all encounters.

Feldman and his co-authors studied encounters between 29 interns and 732 patients with the use of 22 undergraduate pre-med student observers, most of whom were paid about $10 an hour to watch those encounters and document the five behaviors.

Interns at Johns Hopkins were then asked to estimate how frequently they performed those same five behaviors. And for three of the five, the interns overestimated the percentage of times they complied by more than 50%. For example, interns said they introduced themselves to their patients 80% of the time but student observers saw them doing it during only 40% of their patient encounters. Interns said they explained their role 80% of the time, but observers found they did so in only 37%.

Feldman, an associate program director of the Johns Hopkins internal medicine residency program, says that apart from perhaps helping the hospital score better on patient experience surveys, how well interns engage with their patients may very well be a quality of care issue that might be linked to better patient outcomes.

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7 comments on "Doctors in Residency Fail Tests of Common Courtesy"

Pamela D. Simons, MD, MBA, FACOG (10/31/2013 at 11:03 PM)
Given the time limitations of service pressure, the frequent lack of a place to sit down, especially in patient rooms, and the emphasis on EHR, which slows down documentation and prevents eye contact, none of this is surprising. Most residents went into medicine to care for and "be with" patients, but the system increasingly prevents this. It was hard enough 20 years ago when I was in training. Now, it's near-impossible. The practice of medicine increasingly resembles working the front counter at McDonald's. Every layer of administrative demand forced on clinicians increases the cost of providing care and forces us to work faster and gives us less time to think or "be with" our patients in order to generate the same compensation.

JS (10/30/2013 at 2:51 PM)
Healthcare is a customer service business, like it or not. In the event of a poor outcome, the provider who showed genuine caring and concern throughout his/her relationship with the patient is less likely to face a law suit than the provider with poor bedside manner. Treat me well as a patient, yeah I probably won't advertise that to all of my friends, but treat me rudely or make me feel like my issue is unimportant, then I will tell all my friends.

Robert Modugno MD MBA FACOG (10/29/2013 at 4:03 PM)
We are a rude society. I am not surprised.




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