Study: Common Courtesy is Often Overlooked in Hospitals

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CC-thumb2Are acts of common courtesy being overlooked in day-to-day interactions between medical professionals and patients?

As healthcare executives, this is an important question to ponder, especially when taking into account the findings of a recent Journal of Hospital Medicine study. According to Cheryl Clark at HealthLeaders Media, not only are these daily acts of courtesy being overlooked, they’re being overlooked by medical interns, who are often modeling their lack of courtesy after behavior they’ve witnessed from their physician mentors.

The study inspected “how 29 interns interacted with 732 patients hospitalized at Johns Hopkins Hospital and the University of Maryland Medical Center during one month, January, 2012” and found that “interns failed to introduce themselves at the start of 60 percent of their patient encounters, failed to explain what role they play in their care with 63 percent, and failed to touch 35 percent of their patients either with a handshake or other reassuring gesture or with a physical exam. They failed to sit down to talk with 91 percent of their patients, and failed to ask 25 percent standard open-ended questions to elicit conversation that reveals more about the patients’ problems and makes them feel more comfortable.”

These five actions are known as etiquette-based medicine. Clark reports, “Interns performed all five of these behaviors during only 4 percent of all encounters.”

Principal author Leonard Feldman, MD, was quick, however, to jump to the defense of the interns, saying, “I don’t think the interns are actively trying to be rude or mean. I just don’t think they’re thinking about the fact that they should be courteous and polite, especially when they’re worried about their patients’ issues of morbidity and mortality, like a possible heart attack or pneumonia.” In fact, the study found that interns think they perform these five actions more often than they actually do.

Naturally, the importance of etiquette-based medicine is paramount in providing quality of care that will ultimately affect patient outcomes. This is why, Feldman asserts, attending physicians need to be focused on modeling courteous behavior.

He said, “Often, we as attending physicians role model behavior that I would consider —if you want to call it rude, I think that would probably be reasonable. We’re not being polite, not showing common courtesy.” In other words, what’s taught in medical school needs to be practiced in the medical environment.

“When I’m the attending physician, I walk in on rounds with the whole team, introduce myself and put out my hand to shake the patient’s hand, and then make the intern who is going to present the case sit down with the patient in a chair next to the bed. I’m showing them how I think it should be done. And they go, ‘You know, that’s how Dr. Feldman does it, so I should be doing it that way,’” Feldman said.

It’s all about the patient, he reminds. Making their care, their understanding of what’s going on, their needs first priority will go a long way in ensuring a hospital or physician’s success in the new value-based environment.

As healthcare executives, have you noticed any negligence for common courtesy among your physician staff? If so, how did you address this and change it? What advice would you give to your colleagues who may be struggling with a similar issue?

-by Pete Fernbaugh

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