The results of an observational study conducted by Johns Hopkins investigators regarding new doctors (first year interns at The Johns Hopkins Hospital and at the University of Maryland Medical Center in Baltimore) that was published this month online in the Journal of Hospital Medicine found that the interns were discourteous to patients. The researchers looked at five key strategies known as etiquette-based communication in their study: introducing oneself, explaining one’s role in the patient’s care, touching the patient, asking open-ended questions such as “How are you feeling today?” and sitting down with the patient.
The study’s investigators followed 29 internal medicine interns at The Johns Hopkins Hospital and at the University of Maryland Medical Center in Baltimore, Maryland for three weeks during January 2012. They were able to observe 732 inpatient encounters during 118 intern work shifts.
The researchers recorded that the interns touched their patients (a physical exam, a handshake, or a gentle caring touch) during 65% of the encounters; they asked open-ended questions during 75% of the visits; they introduced themselves 40% of the time; they explained their roles 37% of the time; and, they sat down during only 9% of the visits.
The researchers also determined that the interns used all five key strategies during only 4% of all encounters with patients.
The study’s results may help explain previous studies that have found that only 10% of patients can name a doctor who cared for them in the hospital — the important connection between doctor and patient is obviously not being effectively established, which affects doctor-patient communications and follow-up care.
Two of the study’s authors suggested that a key reason why the interns were not using the etiquette-based communication strategies is that their supervisors/mentors were not using them, which previous studies have indicated to be true.
The Interns Over-Estimated Their Use Of Courteous Bedside Manner
The researchers conducted a follow-up survey of their observational study six months later that involved 9 of the 10 interns at The Johns Hopkins Hospital. The survey asked if the interns believed that they had used the five key communication strategies. The interns responded that they believed that they had introduced themselves and had explained their roles 80% of the time. They also believed that they had sat down with patients 58% of the time.
One of the study’s authors stated, “Our perception of ourselves is off a lot of the time and that’s why it is so important to have data … It’s no wonder patients don’t feel connected to what we are telling them because many times we are not doing as much as we could to make that connection.”
The researchers suggest that providing chairs and photos of the care team in patient encounter locations along with adding lessons on etiquette-based communication to the medical school curriculum will help improve doctor-patient communication and the doctors’ bedside manner.
We would also suggest that improved bedside manner and better doctor-patient communication will reduce the likelihood that a doctor will be named as a medical malpractice defendant if “things go bad.”
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