Physician discusses etiquette-based medicine

Physician discusses etiquette-based medicine.
Psychiatrist Michael W. Kahn, M.D., writes in the New York Times (12/2, D6) that “high-level skills like reflectiveness and empathy are an important part of medical education these days.” Dr. Kahn notes that, in article he published several months ago in the New England Journal of Medicine, “medical schools may be underemphasizing a much simpler virtue: good manners.” The article contained a description of “a common-sense method for spreading clinical courtesy that” he called “etiquette-based medicine,” and he “proposed a simple, six-step checklist for doctors to follow when meeting a hospitalized patient for the first time.” This list includes asking for permission to enter a room, introducing oneself, shaking hands, explaining the physician’s role vis-à-vis the patient, and asking patients how they feel “about being in the hospital.” Dr. Kahn points out that “etiquette-based medicine rests on the fact that patients derive comfort from specific actions – as opposed to attitudes or feelings – that are independent of the doctor’s emotional investment in the patient.”

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Research indicates bad behavior on the part of physicians may contribute to medical errors.

On the front page of its Science Times section, the New York Times (12/2, D1, Tarkan) reports that several surveys indicate that “hospital staff members…blame badly behaved doctors for low morale, stress, and high turnover.” In addition, “recent studies suggest that such behavior contributes to medical mistakes, preventable complications, and even death.” For instance, a poll “of healthcare workers at 102 nonprofit hospitals from 2004 to 2007 found that 67 percent of respondents said they thought there was a link between disruptive behavior and medical mistakes, and 18 percent said they knew of a mistake that occurred because of an obnoxious doctor.” Still, “physicians and nurses say they have seen less of it in the past five or 10 years, though it is still a major problem, and the Joint Commission is requiring hospitals to have a written code of conduct, and a process for enforcing it.”