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Civility in Medicine: 6 Habits of Highly Respectful Physicians

Richard Colgan, MD

Volume 56 - Issue 3 - March 2016

Patients want their health care providers to be polite and civil as well as competent. Tips on how to practice etiquette-based medicine, as advanced by Michael W. Kahn, MD,1,2 are presented here in the first part of this guest commentary, which has been excerpted from my book, Advice to the Healer: On the Art of Caring.3 The second part, to be published in an upcoming issue, will expand on this concept with a look at 25 rules of civil conduct, authored by P. M. Forni, PhD, and how these rules may be incorporated into our clinical practice.4

A healer must uphold a professional, considerate, and kind manner during all interactions with his or her patients. This notion applies from the time of introduction and initial exam, through follow-up consults, visits with family members, and any other patient encounter. Hippocrates explains how physicians should compose themselves from the very moment they meet the patient. In Decorum, we are taught upon entering a patient’s room to “bear in mind [our] manner of sitting, reserve, arrangement of dress, decisive utterance, brevity of speech, composure, bedside manners, [and] care.”5 Dr Michael W. Kahn, a psychiatrist from Beth Israel Deaconess Medical Center and assistant professor of psychiatry at Harvard Medical School, published an article in the New England Journal of Medicine which highlights our patients’ desires and expectations to be treated by doctors that are well behaved.1 I think the lessons of this study are applicable to all clinicians. As thoughtful practitioners, we are well aware of the humanistic and caring qualities that are required for the most effective health care delivery. However, Kahn speculates that many “patients may care less about whether their doctors are reflective and empathic than whether they are respectful and attentive.”1 Dr Kahn notes that most patients complain not of being misunderstood or denied empathy but rather of physician behaviors they perceive as rude or neglectful. Dr Kahn believes that good manners can be learned; moreover, he elucidates how physicians should be reminded to cultivate these behaviors so as to practice “etiquette-based medicine.”1

Dr Kahn explains how it is simpler to change physician behavior than patient attitudes:

Etiquette-based medicine would prioritize behavior over feeling. It would stress practice and mastery over character development. It would put professionalism and patient satisfaction at the center of the clinical encounter and bring back some of the elements of ritual that have always been an important part of the healing professions.1

There have evolved many behaviors that are not only expected by the patient, but are seen as standards of care by many institutions. Thus, there has evolved many suggestions for physicians providing care to hospitalized patients to act in a way that is valued by patients. The following checklist, also reported in the New York Times, offers six simple behaviors that are shown to be perceived by the patient as professional and attentive.2

The Six Habits of Highly Respectful Physicians:

  1. Ask permission to enter the room and wait for an answer before doing so.
  2. Introduce yourself, showing your ID badge.
  3. Shake hands with your patient (wear gloves if needed).
  4. Sit down and smile if appropriate.
  5. Briefly explain your role on the patient’s health care team.
  6. Ask the patient how he or she is feeling about being in the hospital and listen to the response.

Etiquette-based medicine is such a simple, obvious necessity in the practice of medicine. So much so, that you almost have to wonder why it is being promoted at all. Isn’t this already the standard of care? Don’t physicians aspire to practice medicine through good behavior? The answers to these questions are not straightforward and are unfortunately compounded by the sad reality that these simple expectations are not always met. Etiquette-based medicine is not uniformly practiced today.

Richard Colgan, MD, is a professor and the vice chair for medical student education and clinical operations in the Department of Family and Community Medicine at the University of Maryland School of Medicine in Baltimore. For more, visit his website, www.advicetotheyoungphysician.com.

References:

  1. Kahn MW. Etiquette-based medicine. N Engl J Med. 2008;358(19):1988-1989.
  2. Kahn MW. The six habits of highly respectful physicians. New York Times. December 1, 2008. http://www.nytimes.com/2008/12/02/health/02etiq.html. Accessed March 2, 2016.
  3. Colgan R. Civility. In: Colgan R. Advice to the Healer: On the Art of Caring. 2nd ed. New York, NY: Springer; 2013:chap 7.
  4. Forni PM. Choosing Civility: The Twenty-Five Rules of Considerate Conduct. New York, NY: St Martin’s Press; 2002.
  5. Hippocrates. The Genuine Works of Hippocrates: Decorum. Adams F, trans. Philadelphia, PA: Williams and Wilkins; 1939.