Connecting with the patient – it’s a hot topic because hospitals are concerned about patient satisfaction scores. We should be concerned because it’s part of the service we are providing and can impact patient outcomes. There’s a component that is about common courtesy. We need physicians to lead the way but a new study raises concerns:
In the study, interns failed to introduce themselves at the start of 60% of their patient encounters, failed to explain what role they play in their care with 63%, and failed to touch 35% 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% of their patients, and failed to ask 25% of patients standard open-ended questions to elicit conversation that reveals more about the patients' problems and makes them feel more comfortable. Interns observed interacting with hospitalized patients exhibited five basic behaviors associated with etiquette-based medicine during only 4% of all encounters. (To learn more, click here.)
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. Not surprisingly, the interns’ estimate of how often they performed these behaviors was much higher than what was objectively observed. Lawrence Feldman, M.D., one of the study’s authors, noted in a recent article in HealthLeaders Media:
- How well interns engage with their patients may very well be a quality of care issue that might be linked to better patient outcomes, particularly when managing chronic disease.
- Often the problem is that the appropriate behaviors are not being modeled by more senior physicians.
- For any patient, the experience "has got to be daunting. They've met several emergency room physicians, the intern that's going to take care of them, the whole Hopkins team that rounds the next morning, possibly a pharmacist, a case manager, social worker, a head floor nurse, senior residents, attendings, and maybe a specialty consultant or surgeon.
- Something so simple as placement of a chair by the bed that the intern can sit on to be at eye-level with the patient can help enormously. "That's some of the culture we need to change. Patients should expect us to sit with them.”
All of this applies to everyone who interacts with a patient. Imagine an elderly, confused patient watching the endless stream of people coming in and out of the room. How much more comforting it is if each of these people quickly and politely engage the patient – rather than just treating the patient as part of a “task.”
Obviously, training helps but research shows over and over again that some people are naturally more inclined to exhibit these behaviors. High customer service industries understand this and build it into how they train, select and develop employees. Healthcare staffing and recruiting professionals need to incorporate these concepts into their efforts.