Blog | Tuesday, October 29, 2013

QD: News Every Day--Interns skipping the niceties of patient communication

First-year interns rarely do the little courtesies that could establish a rapport with patients, such as introducing themselves, and it may be because their teachers rarely do it, a study found.

Researchers followed 29 internal medicine interns at The Johns Hopkins Hospital and the University of Maryland Medical Center for three weeks in January 2012 and recorded whether the doctors applied five ways of etiquette-based communication: 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.

Results appeared online Oct. 12 at the Journal of Hospital Medicine.

Interns touched their patients (such as a physical exam, handshake or a gentle touch) during 65% of visits and asked open-ended questions 75% of the time. But they introduced themselves only 40% of the time, explained their role only 37% of the time and sat down during only 9% of visits. Interns performed all five of the recommended behaviors during 4% of all patient encounters, and were only slightly more likely to introduce themselves to patients during their first encounter than a later one.

In a follow-up study 6 months later, researchers surveyed 9 of the 10 interns, asking how often they believe they used the 5 communication strategies. The interns estimated they introduced themselves to their patients and explained their role 80% of the time and that they sat down with patients 58% of the time.

“Basic things make a difference in patient outcomes and they’re not being done to the extent they should be,” says study leader Leonard S. Feldman, MD, FACP, who is also one of the associate program directors of the internal medicine residency. “These are things that matter to patients and are relatively easy to do.”

The researchers suggested that internal medicine trainees may not do the little things that ease patients’ time in the hospital because their teachers don’t either. Simple steps to improve interns’ manners could include providing chairs and photos of the care team in patient rooms and adding lessons on etiquette-based communication to the curriculum.

Dr. Feldman said in a press release that when he brings trainees into a patient room on rounds, he has everyone introduce themselves. Even if it’s unlikely the patient will remember everyone, it creates a better relationship, he says, adding that modeling appropriate behavior for interns is a good place to start.

“The hospital is a dizzying place,” Dr. Feldman said. “It’s a new crew all the time—in the emergency room, on the unit, the day team, the night team, the nurses, the respiratory therapist, the pharmacist. By introducing ourselves, we can go a long way toward making the entire hospital experience a little less daunting.”